Reader Response: Association of Migraine With Incident Hypertension After Menopause: A Longitudinal Cohort Study
VINOD KGUPTA, Physician-Medical Director, GUPTA MEDICAL CENTRE, MIGRAINE-HEADACHE INSTITUTE, S-407, Greater Kailash-Part Two, New Delhi - 110048, INDIA
Submitted April 28, 2021
MacDonald et al. characterize post-menopausal migraine with hypertension and found an increased risk of hypertension in migraine patients.1 No clinical difference exists in the phenotype and pharmacology of headache between migraine with aura (MA+) and migraine without aura (MA-) patients,2,3 but this study underscores such a difference. While the pathophysiology of migraine is nebulous—despite a plethora of brain-centric theories2,3—the promise of big data with advanced mathematical statistics4 has not advanced its comprehension. Just like meta-analysis introduces a façade of mathematical acceptability that draws clinicians away from biological reality,3 very large research populations can generate false conclusions; or at best, conclusions that will never be replicated.
The investigators have evaluated 56,202 menopausal women and found a migraine history to be statistically linked with hypertension.1 Hypertension, itself, is an etiologically multifactorial disorder across varied psychosocial strata.5 Research conclusions based on big data derived from diverse patients, diverse providers, and diverse clinical settings must be scrutinized critically. Hypertension is itself linked with a headache similar in presentation to migraine by lay patients in ever/never questionnaire studies.5 Physiology of migraine between attacks and during attacks changes dramatically. Between attacks, a low-blood pressure generally prevails – an adaptive function.3,5
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
MacDonald CJ, El Fatouhi D, Madika AL, et al. Association of Migraine With Incident Hypertension After Menopause: A Longitudinal Cohort Study [published online ahead of print, 2021 Apr 21]. Neurology. 2021;10.1212/WNL.0000000000011986. doi:10.1212/WNL.0000000000011986
Gupta VK. Pathophysiology of migraine: an increasingly complex narrative to 2020. Future Neurol. 2019;14:2. 10.2217/fnl-2019-0003
Gupta VK. Adaptive Mechanisms in Migraine. A Comprehensive Synthesis in Evolution. Breaking the Migraine Code. New York: Nova Science Publications, 2009.
Cave A, Brun NC, Sweeney F, Rasi G, Senderovitz T; HMA-EMA Joint Big Data Taskforce. Big Data - How to Realize the Promise. Clin Pharmacol Ther. 2020;107(4):753-761. doi:10.1002/cpt.1736
Gupta VK. Systemic hypertension, headache, and ocular hemodynamics: a new hypothesis. MedGenMed. 2006;8(3):63. Published 2006 Sep 12.
MacDonald et al. characterize post-menopausal migraine with hypertension and found an increased risk of hypertension in migraine patients.1 No clinical difference exists in the phenotype and pharmacology of headache between migraine with aura (MA+) and migraine without aura (MA-) patients,2,3 but this study underscores such a difference. While the pathophysiology of migraine is nebulous—despite a plethora of brain-centric theories2,3—the promise of big data with advanced mathematical statistics4 has not advanced its comprehension. Just like meta-analysis introduces a façade of mathematical acceptability that draws clinicians away from biological reality,3 very large research populations can generate false conclusions; or at best, conclusions that will never be replicated.
The investigators have evaluated 56,202 menopausal women and found a migraine history to be statistically linked with hypertension.1 Hypertension, itself, is an etiologically multifactorial disorder across varied psychosocial strata.5 Research conclusions based on big data derived from diverse patients, diverse providers, and diverse clinical settings must be scrutinized critically. Hypertension is itself linked with a headache similar in presentation to migraine by lay patients in ever/never questionnaire studies.5 Physiology of migraine between attacks and during attacks changes dramatically. Between attacks, a low-blood pressure generally prevails – an adaptive function.3,5
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References