Food insecurity and migraine

Food security describes the concept of having access to food under the aspect of nutritional well-being (1). In contrast, food insecurity occurs when individuals do not have adequate physical, social, or economic access to sufficient, safe, and nutritious food which meets their dietary needs and food preferences for an active and healthy life (2). A large body of research has identified risk factors for food insecurity, including income, socioeconomic status, race and ethnicity, and has suggested that the association between health and food insecurity may be bidirectional (3). Although the association between food insecurity and some chronic health conditions has been previously examined, little is known about the association between migraine and food insecurity. Previous studies have suggested that specific food items may be triggering factors for migraine (4,5) and individuals with migraine have or develop a specific food utilization pattern (6) suggesting an interplay between migraine and food intake. Additionally, migraine and food insecurity both share associations with factors like socioeconomic status, body weight, and depression. In this issue of Cephalalgia, Dooley and colleagues evaluate the cross-sectional association between food insecurity and migraine in a Canadian community health survey (7). Among those who reported a physician-diagnosed migraine, 14.8% experienced food insecurity while only 6.8% of those not reporting migraine experienced food insecurity (odds ratio 2.4, 95% confidence interval 2.0–2.8). The authors also explored whether variables previously associated with food insecurity in other populations were associated with food insecurity among those who reported migraine. Age, gender, total household income, family size, owning one’s dwelling, self-perceived health, and reported mood disorder were all associated with food insecurity among migraineurs. After adjusting for these factors, the association between migraine and food insecurity persisted. The authors also explored whether food insecurity was unique to migraine or if other conditions were also associated with food insecurity. They observed that asthma and arthritis were also associated with food insecurity but bowel disorders and diabetes were not associated with it. The results of this study lead to the following conclusions. First, the factors affecting food insecurity among migraineurs are similar to those seen in previous studies of other populations. Second, previously identified factors for food insecurity cannot account for the association between migraine and food insecurity. Third, although migraine was associated with food insecurity, the association between other chronic health conditions and food insecurity suggests that this association is not unique and may be due to the chronic nature and functional consequences of migraine rather than the specific biological mechanisms which cause it. While this study helps to highlight the higher prevalence of food insecurity among migraineurs compared to those without migraine, several questions remain. First, due to its cross-sectional nature, the authors are not able to determine whether food insecurity precedes migraine or occurs after migraine. Second, food insecurity was measured at the household level while migraine was measured at the individual level. We do not know if the health conditions of other members of the household may be the underlying cause of the food insecurity. Third, the authors only examined previously identified risk factors for food insecurity and did not examine whether migraineurs may have additional risk factors for food insecurity compared to the general population. Another unanswered question is if some migraineurs are at higher risk for food insecurity than other migraineurs. For example, are those who experience higher migraine frequency or a higher morbidity burden at increased risk for food insecurity? Better understanding of the underlying causes of food insecurity among migraineurs and the role that

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