Episodic migraine is associated with a more atherogenic lipid profile rather than independent insulin resistance: a...

Cardiometabolic factors may influence migraine biology through metabolic, inflammatory, and vascular mechanisms, but studies examining insulin resistance and dyslipidaemia in migraine have yielded inconsistent results, partly due to heterogeneity in study design, fasting status, and timing of blood sampling relative to migraine attacks. We evaluated insulin-resistance indices and lipid profiles, including derived lipid ratios, in episodic migraine compared with healthy controls under standardised interictal fasting conditions.

In this cross-sectional case-control study, 45 adults with episodic migraine and 45 healthy controls aged 18-50 years underwent 12-hour fasting blood sampling during the interictal period. Co-primary endpoints were homeostatic model assessment of insulin resistance (HOMA-IR), total cholesterol to high-density lipoprotein cholesterol ratio (TC/HDL-C ratio), and atherogenic index of plasma (AIP). Multivariable linear regression models were adjusted for age, sex, body mass index, and smoking.

After adjustment for age, sex, BMI, and smoking, episodic migraine remained associated with a higher TC/HDL-C ratio (B = 0.956, p < 0.001), higher AIP (B = 0.122, p = 0.008), higher total cholesterol, LDL-C, non-HDL-C, and fasting glucose, and lower HDL-C, whereas no adjusted association was found for HOMA-IR or fasting insulin. In unadjusted analyses, triglycerides were also higher in the migraine group. Monthly migraine days and attack intensity were not associated with the co-primary metabolic indices. Exploratory subgroup analyses showed nominal lipid-related differences by aura status, which did not remain significant after false discovery rate correction.

Under standardised interictal fasting conditions, episodic migraine was associated with a more atherogenic lipid profile, including higher TC/HDL-C ratio and AIP. In contrast, fasting surrogate markers of insulin resistance were not associated with episodic migraine after adjustment for selected covariates, although small effects cannot be excluded. Larger longitudinal studies with more detailed metabolic assessment are needed to confirm these findings.