Rhinitis is defined as an inflammation of the lining of the nose and is characterized by nasal symptoms including anterior or posterior rhinorrhea, sneezing, and nasal blockage or itching of the nose. These symptoms occur during two or more consecutive days for more than 1 h on most days [11].
Allergic rhinitis is the most common form of noninfectious rhinitis and is associated with an IgE-mediated immune response against allergens. It is often associated with ocular symptoms [12].
Apart from local disease, allergic rhinitis can cause considerable morbidity including chronic sinusitis and otitis. The condition can also cause irritability and impaired sleep which can affect quality of life by leading to poor performance at school or work, absenteeism from school or work, and chronic tiredness. It can also have detrimental effects on emotional and social wellbeing [13].
Allergic rhinitis, in addition to having an adverse impact on the patient’s quality of life, has potentially serious medical sequelae, including disturbed sleep, exacerbation of asthma, Eustachian tube dysfunction with otitis media, and rhinosinusitis [14, 15].
Migraine is a relatively severe form of headache occurring in attacks usually lasting between 4 h and 3 days, and with disabling accompanying phenomena such as nausea or vomiting, severe intolerance to light, sound, odors, and body movement [16].
Rhinology setting, Perry et al. found that radiography-normal and endoscopy-normal headache patients had a 58% incidence of migraine [17].
The reasons for this correlation may be pathophysiological resemblance between these disorders. Different studies introduced immunologic mediators such as IgE (immunoglobulin E), histamine, tumor necrosis factor-α (TNF-α), calcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP), D2 and F2 prostaglandins, interleukin-1 (IL-1), tryptase, and also activation of mast cells and secondary release of nitric oxide in both conditions [18, 19].
Migraines are a significant source of both medical costs and lost productivity. It has been estimated that they are the most costly neurological disorder [20].
With better but more expensive treatment options becoming available during the last 10–15 years, migraine and other headache disorders has become the subject of considerable interest from the health economic and public health perspective [21].
Migraine and AR have many clinical similarities. It was seen that among patients with sinus headache referred to otolaryngology clinics, up to 75% may have histories compatible with the migraine criterion. Even in a tertiary care, Migraines are a significant source of both medical costs and lost productivity. It has been estimated that they are the most costly neurological disorder [20].
In our practice, we are seeing allergic rhinitis associated with migraine frequently, so we were dealing with selected patients having both allergic rhinitis and migraine.
In this study, we assessed ability of the treatment of allergic rhinitis in patients having migraine associated to decrease the attacks severity and frequency of their migraine.
In a study reported by Wheatley and Tobias (29 January 2015), as regard allergic rhinitis, most common between the ages of twenty and forty and that was close to our results [22].
As regards migraine, Lay and Bronner (May 2009) found that it affects slightly more boys than girls before puberty and two to three times more women than men after puberty [23]. And that agrees with our study in which females were more affected than males (about 63.79%).
In our study, CBC was done to exclude iron deficiency anemia as a cause of migraine (hemoglobin was found between 10.8 and 12.4 mg/dl) that in a 2015 study in pain medicine. Also in a study by David Rosario, George observed that patients with higher levels of IgE (mean 373.75) had more severe headaches compared to those with lower levels of IgE (mean 3523), that agrees with our result.
In a study reported by Barbee et al. in 1981, it says that mean total serum IgE levels were 38 ± 43 KU/l–180 KU/l in normal subjects and 94 ± 93 KU/l in allergic subjects and asthmatics have higher mean IgE levels than those who are suffering from rhinitis [24]. That values agree with our result which showed that IgE levels were high in patients who had allergic rhinitis (mean IgE value was 171.29). Also in a study by David Rosario, George observed that patients with higher levels of IgE (mean 373.75) had more severe headaches compared to those with lower levels of IgE (mean 3523), that agree with our result showed that IgE test (mean 171.2 9) in patients have both allergic rhinitis and migraine [25, 26]. In our study, IgE level among studied patient according to patients’ improvement found to be improved 88.4 ± 94.08 statistically significant difference, partially improved 137.8 ± 236.2 denote statistically significant difference within groups (post hoc analysis), and not improvement 270.2 ± 224 (P value 10.003) statistically significant difference.
Sanders et al. reported that spontaneous basophiles histamine release is increased in migraine patients. In fact, the pattern of this release is similar to the abnormal release patterns seen in patients with atopic dermatitis or food allergies. Twenty-even studies from several centers have suggested that food allergens interact with specific IgE on mast cells and basophils to cause the release of histamine, prostaglandins D and E, and other vasoactive amines that cause vasodilatation and thus may provoke headaches [27]. That copes with our results which show 58.6% of patients improved by antihistaminic treatment.
A controlled clinical trial, in the Journal Article Somerville Bw The relief of acute migraine attacks with an analgesic/antihistamine combination containing paracetamol, codeine phosphate, doxylamine succinate, and caffeine (Mersyndol) compared with that achieved with a placebo, has been studied in a double-blind, crossover trial. Interest in intranasal (IN) administration as a non-invasive route for drug delivery continues to grow rapidly.
In our study, local steroids were used with antihistamines in treatment of allergic rhinitis, with observing their effect on migraine. The 2012 AAN guideline includes studies of histamines, antihistamines, and leukotriene receptor antagonists for migraine prevention. Three class II single-center studies (all from the same center) show the efficacy of histamine for migraine prevention, but in the other hand the role of the central histaminergic system in migraine is unexplored. At present, to predict the net effect of histamine in central networks seems quite impossible. However, both H3R and H4R ligands may theoretically have migraine prophylactic properties, but there seems to be a long and winding road before effective anti-histaminergic treatment against migraine is established. Despite being promising drug targets for several diseases, the lack of specificity and undesired side effects will probably be a major problem ongoing studies on H3 and H4 receptor [28, 29].
People who suffer from severe migraine want fast-acting relief from the pain. When the medication is delivered intranasal—through the nostrils—relief can come in 15 to 30 min which is much faster than waiting for a pill to be dissolved, digested, and distributed throughout the body. This is especially true in the case of migraine.
Measurements of QOL and disabilities have emerged as important complementary approaches for the evaluation of the burden of headaches. Interest in research into the quality of life has been increasing over the last 20 years. But this field is still disregarded by some. However, it is now widely acknowledged that the personal burden of illness, as perceived by the patient, cannot be fully assessed by objective measures of disease severity, because for diseases such as asthma and allergic rhinitis, traditional clinical indices only moderately correlate with how patients feel and are able to function on a daily basis [30].
In our study, we categorized the patients according to MIDA score which was done before and after the treatment into 4 categories: grade I no pain (0%), grade II mild pain (10.34%), grade III moderate pain (75.86%), grade IV sever pain (13.79%) which showed obvious improvement after treatment of their allergic rhinitis by antihistaminic and steroids nasal spray as follow: grade I (43.1%), grade II (15.52%), grade III (32.76%), grade IV (8.62%). Patients on grade I (no disability) showing statistically significant difference being increasing in number, meaning more patients have no pain of migraine after allergic rhinitis treatment, and also patients on grade III (moderate disability) showing statistically significant difference before and after meaning more patients improved with overall percentage of patients’ improvement according to MIDA score as follow: improved (43.1%), partially improved (15.52%), and patients show no improvement (41.38%).
In our study, we categorized the patients according to MIDA score which was done before and after the treatment into 4 categories: grade I no pain (0%), grade II mild pain (10.34%), grade III moderate pain (75.86%), and grade IV sever pain (13.79%), which showed obvious improvement after treatment of their allergic rhinitis by antihistaminic and steroids nasal spray as follow: grade I (43.1%), grade II (15.52%), grade III (32.76%), and grade IV (8.62%). Patients on grade I (no disability) showing statistically significant difference being increasing in number.
Health-related quality of Life (HRQOL) has been considered an important variable to be managed in airway diseases.
In our study, there were significant improvements of patients QOL regarding sleep problems, nasal symptoms, practical problems, non-hay fever symptoms. Activities results also cope with MIDA score results.
In the study in Malaysia to compare QOL and disability between migraine sufferers and no migraine controls, the Malay versions of the WHOQOL-BREF and MIDAS questionnaires were easy to administer and can be completed quickly. No subjects had any difficulty using the instruments, indicating a high quality of the questionnaires. In this study, the overall perception score of QOL and health was significantly lower among migraine patients. This finding is consistent with those from other studies [31,32,33]. That reported a lower perception of QOL and health. The migraine sufferers had substantial and statistically significantly lower total QOL scores, physical health, and psychological health domain scores than the healthy control group. In another study conducted among migraine patients in the USA [34]. The total QOL, physical health, and social functioning scores of the migraine patients were substantially lower than the published norms [30].
In our study, there were significant improvements of patients QOL regarding sleep problems, nasal symptoms, practical problems, and non-hay fever symptoms. Activities result also cope with MIDA score results.
A similar study conducted among the Dutch population [34] reported diminished functioning and well-being among migraines. Consistently, total QOL, physical health, and psychological health scores were significantly lower among UK [35], French [36], Italian [37], and Indian [38] migraine patients than no migraine controls also cope with our results. All these studies agree with our results that there were significant improvement of patients health-related quality of life and MIDA score results after treatment of their allergic rhinitis and subsequent their migrainous attacks [39].
