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. 2023 Oct;63(9):1203-1219.
doi: 10.1111/head.14632. Epub 2023 Oct 5.

Migraine and air pollution: A systematic review

Andrea E Portt  1 , Christa Orchard  1 , Hong Chen  1   2   3   4 , Erjia Ge  1 , Christine Lay  5   6 , Peter M Smith  1   7
Affiliations

Migraine and air pollution: A systematic review

Andrea E Portt et al. Headache. 2023 Oct.

Erratum in

Abstract

Objective: To systematically synthesize evidence from a broad range of studies on the association between air pollution and migraine.

Background: Air pollution is a ubiquitous exposure that may trigger migraine attacks. There has been no systematic review of this possible association.

Methods: We searched for empirical studies assessing outdoor air pollution and any quantified migraine outcomes. We included short- and long-term studies with quantified air pollution exposures. We excluded studies of indoor air pollution, perfume, or tobacco smoke. We assessed the risk of bias with the World Health Organization's bias assessment instrument for air quality guidelines.

Results: The final review included 12 studies with over 4,000,000 participants. Designs included case-crossover, case-control, time series, and non-randomized pre-post intervention. Outcomes included migraine-related diagnoses, diary records, medical visits, and prescriptions. Rather than pooling the wide variety of exposures and outcomes into a meta-analysis, we tabulated the results. Point estimates above 1.00 reflected associations of increased risk. In single-pollutant models, the percent of point estimates above 1.00 were carbon monoxide 5/5 (100%), nitrogen dioxide 10/13 (78%), ozone 7/8 (88%), PM2.5 13/15 (87%), PM10 2/2 (100%), black carbon 0/1 (0%), methane 4/6 (75%), sulfur dioxide 3/5 (60%), industrial toxic waste 1/1 (100%), and proximity to oil and gas wells 6/13 (46%). In two-pollutant models, 16/17 (94%) of associations with nitrogen dioxide were above 1.00; however, more than 75% of the confidence intervals included the null value. Most studies had low to moderate risks of bias. Where differences were observed, stronger quality articles generally reported weaker associations.

Conclusions: Balancing the generally strong methodologies with the small number of studies, point estimates were mainly above 1.00 for associations of carbon monoxide, nitrogen dioxide, ozone, and particulate matter with migraine. These results were most consistent for nitrogen dioxide.

Keywords: ambient air pollution; emergency department visits; environment; headache; headache diary; migraine.

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References

REFERENCES

    1. James SL, Abate D, Abate KH, Abay S, Abbafati C, Abbasi N. The global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990 to 2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789-1858.
    1. World Health Organization, ed. Atlas of Headache Disorders and Resources in the World. World Health Organization; 2011.
    1. World Health Organization. WHO Air Quality Guidelines. Particulate Matter (PM2.5 and PM10), Ozone, Nitrogen Dioxide and Sulfur Dioxide. World Health Organization; 2021.
    1. Borkum JM. The migraine attack as a homeostatic, neuroprotective response to brain oxidative stress: preliminary evidence for a theory. Headache. 2018;58:118-135.
    1. Ye S, Li S, Ma Y, et al. Ambient NO2 exposure induces migraine in rats: evidence, mechanisms and interventions. Sci Total Environ. 2022;844:157102.

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