{"doi":"10.1093/bjd/ljad325","title":"Atopic dermatitis and risk for headache disorders and migraines: a population-based cohort study in children and adults from the UK","abstract":"Dear Editor, Headache disorders are a common problem worldwide.1 Studies have reported that headache disorders are common in patients with atopic dermatitis (AD) owing to genetic risk factors or neuroinflammation, as alterations in interleukin (IL)-4, IL-5 and IL-10 have been observed in patients with migraines.1–5 However, few studies have examined this association in children and adults separately, or assessed the impact of AD severity. We undertook a population-based cohort study in The Health Improvement Network (THIN), an electronic health records database in the UK. We used a validated algorithm6 to classify patients as having AD if they had at least one of five AD diagnostic codes and two AD treatment codes, and matched with up to five controls on age (± 3 years), practice, and having an encounter within 6 months of the index date of the patient with AD. Treatment exposure and referrals were used as a proxy for AD severity, which is an approach that has been used in prior studies.7 Patients with a history of malignancy, HIV, organ transplant or headache/migraine at cohort entry were excluded. The outcome of interest was first headache or migraine diagnosis. Follow-up time began at the latest of first AD diagnosis or, for controls, the encounter date within 6 months of AD index date, practice registration, or Vision date (implementation of quality assurance software). Censoring occurred at the earliest of first occurrence of outcome, transfer out of practice, practice withdrawal from THIN, death, or end of study. We report cumulative incidence rates (IRs) for headache and migraines. Cox proportional hazards models were used to examine incident risk [hazard ratio (HR), 95% confidence interval (CI)] adjusted for sex, age, Townsend deprivation index (neighbourhood-level measure of socioeconomic status), history of atopy, depression, anxiety, and use of hormone medication; body mass index, smoking and alcohol intake were examined in the adult cohort only. Covariates with a biologically plausible relationship to AD and the outcome of interest were added to the full model if the P-value was < 0.05 in univariate models and removed one at a time or maintained if the P-value was < 0.1 and there was a change in the point estimate by 10–15%. Sensitivity analyses were performed to address effect modification by asthma and/or allergic rhinitis and ascertainment bias by restricting analyses to patients with follow-up ≥ 1 year prior to cohort entry, at least 5 years of follow-up, and seen at least once per year during the study period. All data from June 1994 to February 2015 were included. Analyses were performed using Stata (v.17). The study was developed following STROBE guidelines and was approved by the institutional review board of the University of Pennsylvania and the Scientific Review Committee of CSD Medical Research, UK.","journal":"British Journal of Dermatology","year":2023,"id":364463,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9633,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":510088,"name":"Joy Wan","orcid":"0000-0002-0189-0442","position":1,"is_corresponding":false},{"id":950318,"name":"Sonia Wang","orcid":"0000-0002-0369-7697","position":2,"is_corresponding":false},{"id":397179,"name":"Maha N. Syed","orcid":"0000-0002-7639-227X","position":3,"is_corresponding":false},{"id":109443,"name":"Daniel B. Shin","orcid":"0000-0002-4974-2561","position":4,"is_corresponding":false},{"id":588822,"name":"Katrina Abuabara","orcid":"0000-0002-7736-6946","position":5,"is_corresponding":false},{"id":284625,"name":"Joel M. Gelfand","orcid":"0000-0003-3480-2661","position":6,"is_corresponding":false},{"id":1021312,"name":"Zelma C. Chiesa Fuxench","orcid":"0000-0003-0023-4176","position":0,"is_corresponding":true}],"reference_count":7,"raw_metadata":null,"created_at":"2026-07-19T01:14:36.728255Z","pmid":"37671663","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}