DPP-4 is better target to lower migraine rates in patients with type 2 diabetes

DPP-4 inhibitors, compared with sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, led to lower rates of new-onset migraine and chronic migraine in patients with type 2 diabetes in a large health database study.

Dr Chen Ting-Chuan (Taichung Veterans General Hospital, Taiwan) and colleagues analysed data from the TriNetX Database in Taiwan of adults (≥18 years old) with type 2 diabetes who had at least 2 clinic visits between the start of 2012 and the end of 2022 [1]. Patients were excluded from the analysis if they had a prior diagnosis of migraine or chronic migraine. The researchers used propensity-scored matching to generate 3 cohorts for comparison: patients treated with DPP-4 inhibitors versus SGLT2 inhibitors (n=216,631), patients treated with SGLT2 inhibitors versus GLP-1 receptor agonists (n=177,611), and patients treated with DPP-4 inhibitors GLP-1 receptor agonists (n=212,954).

The median follow-up in all cohorts was around 2–3 years. Patients treated with DPP-4 inhibitors compared with SGLT2 inhibitors had a lower incidence of migraine (HR 0.88; 95% CI 0.84–0.91) and lower incidence of chronic migraine (HR 0.78; 95% CI 0.71–0.86). However, patients treated with SGLT2 inhibitors versus GLP-1 receptor agonists did not show a statistically significant difference in either migraine (HR 0.97; 95% CI 0.92–1.02) or chronic migraine (HR 0.94; 95% CI 0.84–1.05), while analysis of the third cohort showed that patients with DPP-4 versus GLP-1 receptor agonist treatment had lower rates of both migraine (HR 0.82; 0.79–0.86) and chronic migraine (HR 0.69; 95% CI 0.63–0.76).

“In conclusion, our study suggests that DPP-4 inhibitors are associated with a lower risk of migraine and chronic migraine in diabetic patients,” said Dr Ting-Chuan. However, “the potential mechanism for this interaction remains uncertain. Further research is needed to confirm these findings and explore their clinical implications.”

1. Ting-Chuan C, et al. Potential therapeutic role of DPP-4 Inhibitors in reducing migraine risk in diabetic patients. 18^th European Headache Congress, 4–7 December 2024, Rotterdam, the Netherlands.

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Posted on 6 January 2025