Rosacea and Migraine: A Systematic Review and Meta-Analysis Update

The association between rosacea and migraine is well-recognized, but the underlying mechanisms remain unclear. Emerging evidence suggests potential benefits of anti-migraine treatments for rosacea, highlighting the need for updated insights. This systematic review and meta-analysis assessed migraine prevalence in rosacea patients, compared it with non-rosacea populations, and explored influencing factors.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched databases for observational studies reporting migraine prevalence or odds ratios (ORs) in rosacea patients. Data were analyzed using random-effects models in R 4.4.1. Heterogeneity was assessed via the Cochran Q test, I² statistics, prediction intervals (PI), leave-one-out analyses, meta-regressions, and Baujat plots.

From 385 screened studies, 11 met the inclusion criteria, with 112,994 rosacea patients and 4,402,330 non-rosacea participants. The prevalence of migraine in rosacea patients was 25% (95% confidence interval [CI], 0.15; 0.35, p < 0.001, I² = 99%; 95% PI, 0.00; 0.62), indicating substantial variability across populations. Compared to controls, rosacea patients had nearly twice the odds of migraine (OR = 1.93, 95% CI, 1.42; 2.64, p < 0.001, I² = 98%; 95% PI, 0.67; 5.53), though the wide PI suggests that in some populations, the association may not be significant.

Qualitative analysis identified erythematotelangiectatic subtype, female gender, age, and severity as potential contributing factors. However, inconsistencies across studies limit definitive conclusions. While we found high migraine prevalence and increased OR in rosacea patients, the substantial heterogeneity underscores the need for further stratification to enhance risk assessment and treatment strategies considering patient and population-level characteristics.