Researchers found a very high prevalence of migraine, along with the same abnormal catecholamine metabolism that characterizes migraine, among a cohort of young women with eating disorders.

STOWE, VT—Migraine may be a risk factor for eating disorders in young women, said Giovanni D’Andrea, MD, at the Headache Cooperative of New England’s 20th Annual Headache Symposium. Dr. D’Andrea, of the Villa Margherita Neurology Clinic, Arcugnano, Italy, and colleagues conducted a study that found a very high prevalence of migraine and a biochemical profile similar to that of migraine among patients with eating disorders.

These findings could have treatment implications, according to Dr. D’Andrea. “It is unknown if the prophylactic treatment of migraine may reduce the risk for eating disorders,” he said. In a follow-up interview with Neurology Reviews, he speculated that “a treatment with dopamine agonist(s) could be useful in reducing eating disorder symptoms and migraine attacks.”

Looking for an Association
Dr. D’Andrea’s group investigated the possibility of a relationship between migraine and eating disorders in response to existing evidence that eating disorders, which have a poorly understood etiology, may share underlying pathophysiologic aspects with migraine. Both conditions are characterized by a high female prevalence, young age of onset, abnormalities of neuronal density of limbic areas, CNS dysfunction, biochemical abnormalities, and personality trait abnormalities.

The study determined the prevalence of migraine and other headaches among participants with eating disorders and compared the tyrosine metabolism profiles of these participants with those of healthy controls. The tyrosine metabolism comparisons focused on the elusive amines tyramine and octopamine and the catecholamines noradrenaline and dopamine. Migraine is associated with low levels of noradrenaline and high levels of tyramine, octopamine, and topamine, and Dr. D’Andrea’s group sought to determine whether eating disorders have similar associations.

A total of 152 participants—125 with eating disorders and 27 controls—were enrolled in the study. All subjects were women ages 18 to 32, and their median age was 25. Of the participants with eating disorders, 71% had anorexia and 29% had bulimia.

Women in the eating disorders group had very high prevalences of primary headache and migraine, 84% and 74%, respectively. Among the participants with migraine, 68% began experiencing migraine attacks before the onset of eating disorders symptoms, 17% began experiencing the attacks at the same time as the onset of eating disorders symptoms, and 15% began experiencing the attacks after the onset of eating disorders symptoms. Seventy-four percent of the participants with migraine had migraine without aura, 10% had possible migraine without aura, 6% had probable migraine without aura, 6% had chronic migraine, and 4% had migraine with aura.

The prevalence of migraine in the eating disorders group was much higher than the 12% to 15% prevalence of migraine in the general population, Dr. D’Andrea and colleagues noted. The hypothesis that migraine is a risk factor for eating disorders in young women is supported by the fact that migraine attacks preceded the occurrence of eating disorders symptoms in most participants, they said.

Tyrosine Metabolism Similarities
The researchers found that participants with eating disorders had significantly higher levels of tyramine and dopamine when compared with controls. In addition, noradrenaline levels were lower in women with eating disorders than in controls. No significant difference was observed in octopamine levels between the two groups.

The increased dopamine levels and decreased noradrenaline levels of women with eating disorders suggest that these participants have the same abnormal catecholamine metabolism that characterizes migraine, said Dr. D’Andrea.

“In both pathologies, [a decrease of] dopamine B-hydroxylase enzyme activity may be one of the underlying biochemical causes. An abnormal activation of the amine elusive metabolism is a common feature of both diseases,” he said. The increased levels of tyramine in participants with eating disorders suggest that tryptophan decarboxylase enzyme activity is increased in such patients, Dr. D’Andrea added.

The tyrosine metabolism profiles changed when the researchers disaggregated the eating disorders group into a cohort of women with anorexia and a cohort with bulimia. While women with anorexia did not differ significantly from controls with regard to tyramine or octopamine levels, women with bulimia had significantly higher levels of tyramine and significantly lower levels of octopamine than those with anorexia or controls.

Looking Forward
Future areas of research include “studies of other elusive amines—tryptamine, phenylethylamine, etc—that are neuromodulators and their relationship with the pertinent neurotransmitters—serotonin, etc,” commented Dr. D’Andrea. “Physiologic studies on the role of elusive amines in the different areas of the CNS” might also be useful, he added.

“A new field of scientific interest is the trace amine–associated receptors and their function in relationship with the mesolimbic dopaminergic system,” said Dr. D’Andrea. “Drugs acting on these receptors offer a possible new prospective treatment of psychiatric and neurologic disorders, including eating disorders and primary headaches.”

—Jack Baney

Suggested Reading
D’Andrea G, Ostuzzi R, Francesconi F, et al. Migraine prevalence in eating disorders and pathophysiological correlations. Neurol Sci. 2009;30(Suppl 1):S55-S59.

A Link Between Migraine and Eating Disorders?