Migraine and Parkinson’s Disease

Written by: Kylie Petrarca RN, BSN

Medically reviewed by: Rebecca Gilbert, MD, PhD

Edited by: Melissa Calise and Leigh Serth

What is Parkinson’s Disease?

Parkinson’s Disease (PD) is a chronic and progressive neurodegenerative disorder. The dopamine producing neurons in the part of the brain that controls movement stops working which results in less dopamine production. Dopamine in this part of the brain enables neurons in your brain to communicate and control movement. The reduction of dopamine causes tremors, lack of coordination, bradykinesia, poor balance, stiffness and more. Parkinson’s disease affects men more than women and the risk increases for those over 60 years old.

How is Parkinson’s Disease Diagnosed?

There is no definitive test to determine if someone has Parkinson’s disease, rather diagnosis is made based on symptoms. A doctor will review a person’s medical history, medications and conduct a physical examination. A DaTscan is a type of imaging that can view the brain’s dopamine system. Although it cannot diagnose Parkinson’s disease, it can help confirm the diagnosis and exclude other causes.

To be diagnosed with Parkinson’s Disease two of the four main characteristics are needed: 

1. Resting tremor
2. Slowness of movement when walking or moving the limbs
3. Postural instability- Unstable when standing
4. Stiffness or rigidity of arms, legs or trunk

Other common symptoms include constipation, sleep problems, cognitive changes, loss of smell, swallowing issues, shuffling gait, soft/slurred speech, depression, expressionless face and more.

What Causes Parkinson’s Disease? 

It is unclear what causes Parkinson’s disease but it is believed to be impacted by environmental and genetic factors.¹ Some genes have been identified that may increase the risk of developing Parkinson’s disease such as LRRK2, GBA, PINK1, PARK2, PARK7 and SNCA.² “Certain ethnic groups like Ashkenazi Jews, North African Arab Berber and Basque populations have a higher prevalence (about 30%) of Parkinson’s than the general population.”² Environmental factors such as herbicides, pesticides, solvents, polychlorinated biphenyls (PCBs), occupation and area of residence have also been linked to the diagnosis but more research is needed.³ For more information on environmental factors and Parkinson’s disease click here.

The Relationship Between Migraine and Parkinson’s Disease 

One study assessing the migraine prevalence in 237 Parkinson’s disease subjects found that 27.8% of patients had migraine within their lifetime and 13.1% of patients currently had migraine.⁴ Interestingly, after the onset of Parkinson’s disease, almost two thirds of PD patients had improvement in their migraine attacks or complete remission.⁴ It is unknown how or why some migraine patients improve or enter a remission phase after the onset of Parkinson’s disease. 

Another notable study found that subjects with a history of migraine with aura had double the risk of Parkinson’s disease compared to controls.⁵ They also found women in this group were more likely to have a parent or sibling with PD compared to controls.⁵ It is unclear why those who have migraine with aura are at a higher risk of PD, however, research is being done to understand how genetics play a role in PD.

Commonalities Between Migraine and Parkinson’s Disease

• Migraine and Parkinson’s disease are comorbid with many of the same diseases such as depression, sleep disorders, anxiety and cardiovascular disease. 
• Traumatic brain injury (TBI) can increase the risk of developing Parkinson’s disease later in life and can also trigger the onset of migraine but it is unclear how a TBI can cause either of these conditions. 
• The use of deep brain stimulation can be used for both conditions. While it is a commonly used treatment for PD, it is not routinely used for migraine. 
• Lower dopamine levels have been seen in both migraine and PD patients. In PD, this is treated with medications that target the dopamine receptor. In migraine, lower dopamine levels have been linked to sensitivity to pain and stimulation (ex. light and sound sensitivity, allodynia, smells, etc.)⁶
• Iron accumulation has been found in both Parkinson’s disease and migraine patients.⁵ In those with PD, iron accumulation was identified in the substantia nigra and in migraine it was identified in the deep brain nuclei.⁵
• Non-invasive vagus nerve stimulation is FDA approved for the acute and preventive treatment of migraine and is currently being studied for Parkinson’s disease.^7,8

What Are the Recommended Pharmacological Treatments for Parkinson’s Disease?

There is not a cure for Parkinson’s Disease. Instead, the goal of treatment is to ease symptoms. Each person with PD may have different symptoms, therefore the treatment plan will often vary person to person.

Overall, many of the medications used for Parkinson’s either target dopamine or acetylcholine, two neurotransmitters believed to be involved in the physiology of the disease. 

Some common medications options include: 

• Carbidopa/levodopa
• Ropinirole (also used to treat restless leg syndrome)
• Amantadine
• Rasagiline
• Entacopone

Advanced treatment options such as an intestinal infusion or deep brain stimulation may be recommended for those with PD patients who do not have symptom relief using oral medications or have an advanced form of the disease.

1. Carbidopa/Levodopa is a prescription medication that can be given through a pump directly into the intestine. A specialist will insert a hole (called a stoma) in the stomach wall in order to place a medication delivery port directly into the intestine. A portable pump is then connected and the patient can hook up the cassette that delivers a gel formulation of the 2 medications.
   

   https://www.duopa.com/how-duopa-works

2. Deep brain stimulation involves implanting electrodes in the part of the brain responsible for motor function. The electrodes are connected to an implantable pulse generator which is surgically placed under the skin of the chest. A person with PD can turn the impulse generator on and off as needed.

Other treatment options include focused ultrasound, thalamotomy and pallidotomy procedures.

Physical therapy and occupational therapy are two modalities that can help someone with Parkinson’s disease continue daily activities and manage symptoms. Speech therapy is also commonly used to help with swallowing and speaking issues that occur with PD. Other alternative therapies that may be helpful are acupuncture and massage therapy. It is also important for PD patients to maintain a healthy diet, exercise and learn tips for preventing falls.

What Type of Doctor Should I See For Parkinson’s Disease and Migraine?

A neurologist is the preferred specialist for someone living with Parkinson’s disease. Some neurologists take additional training to become movement disorder specialists. This type of specialist should be consulted soon after a PD diagnosis because they often have insight on new therapies and studies. To find a movement specialist near you, visit: https://mds.movementdisorders.org/directory/

Similarly, neurologists are recommended to diagnose and treat migraine disease. A clinician with a headache specialty is preferred for someone who believes they may have migraine or headache disease.

A Note to Patients and Providers 

It is important for Parkinson’s Disease patients to inform their providers if they are having symptoms of migraine disease. Likewise, neurologists should be aware of new symptoms in their migraine patients such as tremors, stiffness and loss of balance as this may lead to an earlier diagnosis of Parkinson’s disease. 

Parkinson’s Foundation began a national initiative known as PD GENEration: Mapping the Future of Parkinson’s Disease. This program offers free genetic testing and counseling for people with the disease, click here to learn more. This program is only for people diagnosed with Parkinson’s disease. 

Patients who live with brain diseases such as Parkinson’s or migraine may consider donating their brain to the Brain Donor Project after death so brain diseases can be further researched. Learn more about brain donation here. 

For researchers, further studies could look to identify how deep brain stimulation can further improve symptoms of both these diseases. In addition, understanding why migraine tends to improve with the onset of PD is another knowledge gap that needs further exploration.

Allied Partners

Thank you to our partners, American Parkinson Disease Association and the Brain Donor Project for your support!

Patient Resources  

1. What is Parkinson’s Disease? By the American Parkinson Disease Association
2. Treatments and Medications By the American Parkinson Disease Association
3. APDA Webinar Series
4. PD GENEration: Mapping the Future of Parkinson’s Disease
5. Find Local Resources By the American Parkinson Disease Association

Thank You to Our Sponsors!

References 

1. https://www.parkinson.org/understanding-parkinsons/causes/genetics
2. https://www.parkinson.org/understanding-parkinsons/causes/genetics/common-genetic-mutations#:~:text=Certain%20ethnic%20groups%20like%20Ashkenazi,in%20the%20loss%20of%20neurons
3. https://www.parkinson.org/Understanding-Parkinsons/Causes/Environmental-Factors
4.  Barbanti P, Fabbrini G, Vanacore N, et al. Dopamine and Migraine: Does Parkinson’s Disease Modify Migraine Course? Cephalalgia. 2000;20(8):720-723. doi:10.1111/j.1468-2982.2000.00123.x
5. Scher, A. I., Ross, G. W., Sigurdsson, S., Garcia, M., Gudmundsson, L. S., Sveinbjörnsdóttir, S., Wagner, A. K., Gudnason, V., & Launer, L. J. (2014). Midlife migraine and late-life parkinsonism: AGES-Reykjavik study. Neurology, 83(14), 1246–1252. https://doi.org/10.1212/WNL.0000000000000840
6. https://www.psychologytoday.com/us/blog/the-red-light-district/201704/why-do-dopamine-levels-fluctuate-during-migraines
7. Mondal, B., Choudhury, S., Banerjee, R. et al. Non-invasive vagus nerve stimulation improves clinical and molecular biomarkers of Parkinson’s disease in patients with freezing of gait. npj Parkinsons Dis. 7, 46 (2021). https://doi.org/10.1038/s41531-021-00190-x
8. Bohnen NI, Yarnall AJ, Weil RS, Moro E, Moehle MS, Borghammer P, Bedard MA, Albin RL. Cholinergic system changes in Parkinson’s disease: emerging therapeutic approaches. Lancet Neurol. 2022 Apr;21(4):381-392. doi: 10.1016/S1474-4422(21)00377-X. Epub 2022 Feb 4. PMID: 35131038.
9. Image: https://www.duopa.com/how-duopa-works

*The contents of this blog are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The writer does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.