Neurological Sciences

, Volume 35, Issue 10, pp 1573–1578 | Cite as

Non-alcoholic fatty liver disease in patients with migraine

  • Asuman CelikbilekEmail author
  • Mehmet Celikbilek
  • Aylin Okur
  • Serkan Dogan
  • Elif Borekci
  • Mustafa Kozan
  • Sebnem Gursoy
Original Article


Evidence suggests that migraine is associated with metabolic syndrome, which is also implicated in non-alcoholic fatty liver disease (NAFLD). Reported for the first time, we aimed to investigate the relationship between migraine and NAFLD in patients with migraine. A total of 90 consecutive migraine patients were enrolled in this cross-sectional study. The diagnosis of migraine was determined according to the International Classification of Headache Disorders-II diagnostic criteria. The diagnosis of NAFLD was based on abdominal ultrasonography findings. Anthropometric indices and the homeostasis model assessment of insulin resistance (HOMA-IR) were calculated, and serum insulin level measurements and other biochemical analyses were performed for each subject. The measurements of body mass index and waist circumference were significantly higher in migraine patients with NAFLD than in those without NAFLD (p < 0.001). Regarding the laboratory results, insulin (p = 0.024), alanine aminotransferase (p = 0.027), and triglyceride levels (p = 0.001) and the HOMA-IR (p = 0.039) were higher in migraineurs with NAFLD than in those without NAFLD. Among the headache characteristics, the presence of aura was higher, and disease and attack durations were significantly longer in migraineurs with NAFLD than in those without NAFLD (p = 0.005, p = 0.024, and p = 0.023; respectively). However, the headache characteristics did not correlate with either the hepatosteatosis grade or HOMA-IR in migraine patients (p > 0.05). Our results show that NAFLD may present in migraine patients with higher frequency of auras and longer disease and attack durations.


Insulin resistance Metabolic syndrome Migraine Non-alcoholic fatty liver disease 


Conflict of interest



  1. 1.
    Casucci G, Villani V, Cologno D, D’Onofrio F (2012) Migraine and metabolism. Neurol Sci 33(Suppl 1):S81–S85 PubMed PMID: 22644177. Epub 2012/06/01. engPubMedCrossRefGoogle Scholar
  2. 2.
    Sachdev A, Marmura MJ (2012) Metabolic syndrome and migraine. Front Neurol 3:161 PubMed PMID: 23181051. Pubmed Central PMCID: PMC3500825. Epub 2012/11/28. engPubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Guldiken B, Guldiken S, Taskiran B, Koc G, Turgut N, Kabayel L et al (2009) Migraine in metabolic syndrome. Neurologist 15(2):55–58PubMedCrossRefGoogle Scholar
  4. 4.
    Alberti KG, Zimmet P, Shaw J (2006) Metabolic syndrome––a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabet Med 23(5):469–480 PubMed PMID: 16681555. Epub 2006/05/10. engPubMedCrossRefGoogle Scholar
  5. 5.
    Bhoi SK, Kalita J, Misra UK (2012) Metabolic syndrome and insulin resistance in migraine. J Headache Pain 13(4):321–326 PubMed PMID: 22278639. Pubmed Central PMCID: PMC3356472. Epub 2012/01/27. engPubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Guldiken B, Guldiken S, Demir M, Turgut N, Kabayel L, Ozkan H et al (2008) Insulin resistance and high sensitivity C-reactive protein in migraine. Can J Neurol Sci (Le journal canadien des sciences neurologiques) 35(4):448–451 PubMed PMID: 18973061. Epub 2008/11/01. engGoogle Scholar
  7. 7.
    Rainero I, Limone P, Ferrero M, Valfre W, Pelissetto C, Rubino E et al (2005) Insulin sensitivity is impaired in patients with migraine. Cephalalgia 25(8):593–597 PubMed PMID: 16033384. Epub 2005/07/22. engPubMedCrossRefGoogle Scholar
  8. 8.
    Cavestro C, Rosatello A, Micca G, Ravotto M, Marino MP, Asteggiano G et al (2007) Insulin metabolism is altered in migraineurs: a new pathogenic mechanism for migraine? Headache 47(10):1436–1442 PubMed PMID: 18052953. Epub 2007/12/07. engPubMedCrossRefGoogle Scholar
  9. 9.
    Gao X, Fan JG, Study Group of Liver Metabolism CSoE (2013) Diagnosis and management of non-alcoholic fatty liver disease and related metabolic disorders: consensus statement from the Study Group of Liver and Metabolism, Chinese Society of Endocrinology. J Diabetes 5(4):406–415 PubMed PMID: 23560695PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Wang Y, Li YY, Nie YQ, Zhou YJ, Cao CY, Xu L (2013) Association between metabolic syndrome and the development of non-alcoholic fatty liver disease. Exp Ther Med 6(1):77–84 PubMed PMID: 23935723. Pubmed Central PMCID: PMC3735568. Epub 2013/08/13. EngPubMedPubMedCentralGoogle Scholar
  11. 11.
    Tarantino G, Finelli C (2013) What about non-alcoholic fatty liver disease as a new criterion to define metabolic syndrome? World J Gastroenterol 19(22):3375–3384 PubMed PMID: 23801829. Pubmed Central PMCID: PMC3683675. Epub 2013/06/27. engPubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Yilmaz Y (2012) Is nonalcoholic fatty liver disease the hepatic expression of the metabolic syndrome? World J Hepatol 4(12):332–334 PubMed PMID: 23355910. Pubmed Central PMCID: PMC3554796. Epub 2013/01/29. engPubMedPubMedCentralGoogle Scholar
  13. 13.
    Saran S, Philip R, Gutch M, Tyagi R, Agroiya P, Gupta KK (2013) Correlation between liver fat content with dyslipidemia and Insulin resistance. Indian J Endocrinol metab 17(Suppl 1):S355–S357 PubMed PMID: 24251213. Pubmed Central PMCID: PMC3830359. Epub 2013/11/20. engPubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Kotronen A, Westerbacka J, Bergholm R, Pietilainen KH, Yki-Jarvinen H (2007) Liver fat in the metabolic syndrome. J Clin Endocrinol Metab 92(9):3490–3497 PubMed PMID: 17595248. Epub 2007/06/28. engPubMedCrossRefGoogle Scholar
  15. 15.
    Torelli P, Beghi E, Manzoni GC (2004) Appendix to the ınternational classification of headache disorders (2nd edition): application of diagnostic criteria for tension-type headache. Cephalalgia 24(9):791 PubMed PMID: WOS:000223377900069. EnglishGoogle Scholar
  16. 16.
    Azapagasi E, Alehan F, Saygi S, Bayraktar N, Yazici AC (2012) Serum concentrations of neuron-specific enolase in pediatric migraine. Turk J Pediatr 54(2):150–155 PubMed PMID: 22734301PubMedGoogle Scholar
  17. 17.
    Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E et al (2011) Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology (Baltimore, MD) 54(3):1082–1090 PubMed PMID: 21618575. Epub 2011/05/28. engCrossRefGoogle Scholar
  18. 18.
    Quinn SF, Gosink BB (1985) Characteristic sonographic signs of hepatic fatty infiltration. Am J Roentgenol 145(4):753–755CrossRefGoogle Scholar
  19. 19.
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7):412–419PubMedCrossRefGoogle Scholar
  20. 20.
    Gozke E, Unal M, Engin H, Gurbuzer N (2013) An observational study on the association between migraines and tension type headaches in patients diagnosed with metabolic syndrome. ISRN Neurol 2013:147065 PubMed PMID: 23691357. Pubmed Central PMCID: PMC3654231. Epub 2013/05/22. engPubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Gruber HJ, Bernecker C, Pailer S, Fauler G, Horejsi R, Moller R et al (2010) Hyperinsulinaemia in migraineurs is associated with nitric oxide stress. Cephalalgia 30(5):593–598 PubMed PMID: 19740122. Epub 2009/09/11. engPubMedGoogle Scholar
  22. 22.
    Fava A, Pirritano D, Consoli D, Plastino M, Casalinuovo F, Cristofaro S et al (2013) Chronic migraine in women is associated with insulin resistance: a cross-sectional study. Eur J Neurol 21(2):267–272. doi: 10.1111/ene.12289. Epub 2013 Nov 15 Google Scholar
  23. 23.
    Sacco S, Altobelli E, Ornello R, Ripa P, Pistoia F, Carolei A (2013) Insulin resistance in migraineurs: results from a case-control study. Cephalalgia 34(5):349–356. doi: 10.1177/0333102413511155. Epub 2013 Nov 15Google Scholar
  24. 24.
    Tietjen GE (2009) Migraine as a systemic vasculopathy. Cephalalgia 29(9):987–996 PubMed PMID: 19689607. Epub 2009/08/20. engPubMedCrossRefGoogle Scholar
  25. 25.
    Hamed SA, Hamed EA, Ezz Eldin AM, Mahmoud NM (2010) Vascular risk factors, endothelial function, and carotid thickness in patients with migraine: relationship to atherosclerosis. J Stroke Cerebrovasc Dis 19(2):92–103 PubMed PMID: 20189084. Epub 2010/03/02. engPubMedCrossRefGoogle Scholar
  26. 26.
    Winsvold BS, Hagen K, Aamodt AH, Stovner LJ, Holmen J, Zwart JA (2011) Headache, migraine and cardiovascular risk factors: the HUNT study. Eur J Neurol 18(3):504–511 PubMed PMID: 20825470. Epub 2010/09/10. engPubMedCrossRefGoogle Scholar
  27. 27.
    Winsvold BS, Sandven I, Hagen K, Linde M, Midthjell K, Zwart JA (2013) Migraine, headache and development of metabolic syndrome: an 11-year follow-up in the Nord-Trondelag Health Study (HUNT). Pain 154(8):1305–1311PubMedCrossRefGoogle Scholar
  28. 28.
    Bigal ME, Kurth T, Santanello N, Buse D, Golden W, Robbins M et al (2010) Migraine and cardiovascular disease: a population-based study. Neurology 74(8):628–635 PubMed PMID: 20147658. Pubmed Central PMCID: PMC3462501. Epub 2010/02/12. engPubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Scher AI, Terwindt GM, Picavet HS, Verschuren WM, Ferrari MD, Launer LJ (2005) Cardiovascular risk factors and migraine: the GEM population-based study. Neurology 64(4):614–620 PubMed PMID: 15728281. Epub 2005/02/25. engPubMedCrossRefGoogle Scholar
  30. 30.
    Moschiano F, D’Amico D, Usai S, Grazzi L, Di Stefano M, Ciusani E et al (2008) Homocysteine plasma levels in patients with migraine with aura. Neurol Sci 29(Suppl 1):S173–S175 PubMed PMID: 18545927. Epub 2008/07/17. engPubMedCrossRefGoogle Scholar
  31. 31.
    Gudmundsson LS, Scher AI, Aspelund T, Eliasson JH, Johannsson M, Thorgeirsson G et al (2010) Migraine with aura and risk of cardiovascular and all cause mortality in men and women: prospective cohort study. BMJ (Clinical research ed) 341:c3966 PubMed PMID: 20736269. Pubmed Central PMCID: PMC2927696. Epub 2010/08/26. engCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Sarchielli P, Alberti A, Baldi A, Coppola F, Rossi C, Pierguidi L et al (2006) Proinflammatory cytokines, adhesion molecules, and lymphocyte integrin expression in the internal jugular blood of migraine patients without aura assessed ictally. Headache 46(2):200–207 PubMed PMID: 16492228. Epub 2006/02/24. engPubMedCrossRefGoogle Scholar
  33. 33.
    Tilg H (2010) The role of cytokines in non-alcoholic fatty liver disease. Dig Dis (Basel, Switzerland) 28(1):179–185 PubMed PMID: 20460908. Epub 2010/05/13. engCrossRefGoogle Scholar
  34. 34.
    Tilg H (2010) Adipocytokines in nonalcoholic fatty liver disease: key players regulating steatosis, inflammation and fibrosis. Curr Pharm Des 16(17):1893–1895 PubMed PMID: 20370678. Epub 2010/04/08. engPubMedCrossRefGoogle Scholar
  35. 35.
    Perini F, D’Andrea G, Galloni E, Pignatelli F, Billo G, Alba S et al (2005) Plasma cytokine levels in migraineurs and controls. Headache 45(7):926–931 PubMed PMID: 15985111. Epub 2005/06/30. engPubMedCrossRefGoogle Scholar
  36. 36.
    Bigal ME, Lipton RB, Holland PR, Goadsby PJ (2007) Obesity, migraine, and chronic migraine: possible mechanisms of interaction. Neurology 68(21):1851–1861 PubMed PMID: 17515549. Epub 2007/05/23. engPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Asuman Celikbilek
    • 1
    Email author
  • Mehmet Celikbilek
    • 2
  • Aylin Okur
    • 3
  • Serkan Dogan
    • 4
  • Elif Borekci
    • 5
  • Mustafa Kozan
    • 5
  • Sebnem Gursoy
    • 4
  1. 1.Department of NeurologyBozok University, School of MedicineYozgatTurkey
  2. 2.Department of GastroenterologyBozok University, School of MedicineYozgatTurkey
  3. 3.Department of RadiologyBozok University, School of MedicineYozgatTurkey
  4. 4.Department of GastroenterologyErciyes University, School of MedicineKayseriTurkey
  5. 5.Department of Internal MedicineBozok University, School of MedicineYozgatTurkey

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