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Is There an Inverse Relationship Between Migraine and Dietary Sodium Intake?

Migraine is a common disorder that affects about 15% of the general population. The disease limits daily, professional and educational activities, and impairs interpersonal relationships. The pathophysiology of migraine is still unclear. Recently, a novel result was published by Pogoda et al that reports a remarkable conclusion. Although, high dietary sodium intake is usually related to the occurrence of different disorders, Pogoda et al report “This study is the first evidence of an inverse relationship between migraine and dietary sodium intake.” In their study, they have used data from the National Health and Nutrition Examination Survey (NHANES). Enrollment for their study, using data collected between 1999 and 2004, consisted of all adults older than 20 years of age that fulfilled the study criteria and did not take any analgesic medications. In the Pogoda study, the identification of “migraine” was based on self-reports and not according to the International Headache Classification criteria. They asked the following question: “During the past 3 months, did you have severe headaches or migraines?” Although the authors state this part of the study method is a limitation, and the headache group was nonspecific migraine, they have used the word “migraine” in the conclusion of the article. I think the following conclusion would have been more accurate: “This study is the first evidence of an inverse relationship between headache (not migraine) and dietary sodium intake.” There is another confounding issue about this study. In the article, the results are only adjusted for age, sex, and body mass index. But, it is seemly really necessary to also report the blood pressure (BP) measurements and hypertension (HTN) frequency of the study sample as it is clear that a relationship between high salt intake and HTN exists. In the Pogoda study, the only drugs that are mentioned and considered are analgesics. In the treatment of hypertension, beta blockers and calcium channel blockers are used and they are also effective and widely used in migraine prevention. So, usage of these drugs for HTN can be a very remarkable confounding factor and will likely impact the results. In the NHANES survey, the BP analysis is collected. I think the strength of the article could be increased if additional analyses were supplied to show the possible effect of high BP and the drug used for the control of HTN. Maybe high salt intake is indeed associated with high BP, so high usage of beta blockers and calcium channel blockers and finally low frequency of migraine headache occur.