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Year : 2020  |  Volume : 23  |  Issue : 6  |  Page : 745-746

Editorial comment on erectile dysfunction in migraine

Agrim Institute of Neurosciences, Artemis Hospitals Sector 51, Gurgaon, Haryana, India

Date of Submission29-Nov-2020
Date of Acceptance01-Dec-2020
Date of Web Publication18-Dec-2020

Correspondence Address:
Dr. Sumit Singh
Chief of Neurology, Agrim Institute of Neurosciences, Artemis Hospitals, Sector 51, Gurgaon - 122 002, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.AIAN_1218_20

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How to cite this article:
Singh S. Editorial comment on erectile dysfunction in migraine. Ann Indian Acad Neurol 2020;23:745-6

How to cite this URL:
Singh S. Editorial comment on erectile dysfunction in migraine. Ann Indian Acad Neurol [serial online] 2020 [cited 2021 Jan 16];23:745-6. Available from:

The authors have attempted to evaluate the association of migraine and erectile dysfunction (ED) in male migraineurs in this case control study[1] (Sample size 30). The authors report a very high incidence of ED in migraineurs as compared to the controls (80% as compared to none).

Migraine is a very common problem and affects about 18–20% of the population across the world according to different studies. A large sample might be needed to estimate the incidence or prevalence of ED in migraine, as the disease is so common. Population-based studies across the world accept that ED is much more common (both psychological and organic) in migraineurs as compared to controls. It is unusual to observe that none of the controls in the study reported ED while 80% of the migraine patients did. It appears to be a type II epidemiological error rather than a factual finding. The comorbidities of anxiety and depression tend to worsen ED in these patients, which had been excluded in these patients. This indicates that patients of migraine with these comorbidities are even more likely to have ED. Most drugs used for migraine prophylaxis (Propranolol, Toppiramate,[2] Sodium Valproate[3]), can cause ED themselves, most of the patients in this study were on these drugs, therefore the role of migraine “per se” on ED is questionable.

Wu et al.[4] from Taiwan have evaluated the incidence of ED in migraine based on a population based evaluation of about 5000 patients and 20000 controls. The case: Control ratio is about 1:4 which is an adequate design for population based studies. They followed up the cases and controls over a period of time for variable durations (over a decade) OR till these subjects developed organic/psychological ED. They observed a 1.78 times higher incidence of ED in migraine patients than controls. They also found that the incidence of organic ED was also higher in these patients. They further stated that patients with coexistent anxiety had an even higher (3.6 time higher Hazards ratio) incidence of ED as compared to controls. The authors did a multivariate analysis of the comorbidities and found that migraine was an independent association with ED. They used a COX proportion hazard regression model to evaluate these variables, a robust means of statistical analysis. This result was consistent with the study by Huang et al. which estimated the association between ED and migraines, and the study of Sicuteri et al. that revealed sexual dysfunction was found more often in patients with migraine. The authors have reported presence of endothelial dysfunction in migraine patients as a potential cause or an alteration in the hormonal milieu causing ED.

Huang et al.[5] in a case control study in Taiwan have addressed the question of ED and migraine in a opposite direction as above. They identified 5763 patients with ED and randomly selected 17,289 patients as the controls. Conditional logistic regression was used to calculate the odds ratios (OR) for prior migraine between cases and controls. They observed that after adjusting for various comorbidities, known to cause ED, conditional logistic regression revealed that among ED patients the odds of having been previously diagnosed with migraines was 1.63 (95% CI, 1.39–1.91) that of the control group. This risk was more pronounced in younger groups, with the highest risk being detected among those aged between 30 and 39 years. After adjusting for comorbidities, ED patients aged between 30 and 39 years were found to be at 1.98 (95% CI, 1.67–2.23) times the risk of controls for having been previously diagnosed with migraines. The authors therefore concluded that migraine is an independent association with ED in younger individuals. The authors explain the higher incidence of migraine in patients with ED to be caused by the chronic pain associated with migraine. They also postulate the paucity of dopaminergic activity as a common factor causing both migraine and ED. They also suggest that the higher incidence of migraine in younger patients with ED might be because these patients are more active sexually and therefore, they report ED more frequently as compared to older individuals.

Other smaller studies with similar design[6] have also observed a higher incidence of sexual dysfunction in patients with Tension type headache and migraine, as compared to matched controls. Interestingly, they observed no major difference in the incidence of ED in migraine and tension type headache, thereby mitigating the theory proposed for ED in migraine.

There is little doubt that ED might be more common in migraine as compared to controls; however, the incidence might not be as high as has been reported in the present study. The cause of ED in migraine can be multifactorial and generating a regression model by incorporating the confounding factors like depression, anxiety, drugs, and comorbidities might give a more robust information about this aspect of migraine. It's also important to understand that more information to this problem can be addressed by conducting larger studies, with a higher case: Control ratio.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

   References Top

Nemichandra SC, Pradeep R, Harsha S, Radhika K, Iqbal R. Erectile Dysfunction in Migraine in Indian Patients. Ann Indian Acad Neurol 2020;23:633-6.  Back to cited text no. 1
Chen LW, Chen MY, Chen KY, Lin HS, Chien CC, Yin HL. Topiramate-associated sexual dysfunction: A systematic review. Epilepsy Behav 2017;73:10-7.  Back to cited text no. 2
Verrotti A, Mencaroni E, Cofini M, Castagnino M, Leo A, Russo E, et al. Valproic acid metabolism and its consequences on sexual functions. Curr Drug Metab 2016;17:573-81.  Back to cited text no. 3
Wu S-H, Chuang E, Chuang T-Y, Lin C-L, Lin M-C, Yen D-J, et al. A nationwide population-based cohort study of migraine and organic-psychogenic erectile dysfunction. Medicine (Baltimore) 2016;95:e3065.  Back to cited text no. 4
Huang C-Y, Keller JJ, Sheu J-J, Lin H-C. Migraine and erectile dysfunction: Evidence from a population-based case-control study. Cephalalgia 32:366-72.  Back to cited text no. 5
Aksoy D, Solmaz V, Cevik B, Gencten Y, Erdemir F, Kurt SG. The evaluation of sexual dysfunction in male patients with migraine and tension type headache. J Headache Pain 2013;14:46.  Back to cited text no. 6


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