A systematic review and meta-analysis on the risk of migraine in patients with allergic rhinitis

Background: Allergic rhinitis (AR) and migraine are common chronic conditions that significantly impact patients' quality of life. Although observational studies suggest a potential link between AR and increased migraine risk, evidence remains inconsistent. Objective: To systematically evaluate the association between AR and migraine risk through a comprehensive meta-analysis. Methods: Databases including PubMed, Web of Science, Scopus, and CNKI were systematically searched up to July 2025. Observational studies investigating the association between AR and migraine were included. Data extraction, quality assessment, and meta-analysis were performed following PRISMA guidelines. Random-effects models were utilized, and subgroup analyses were conducted (by study design, age group, and effect measure). Sensitivity analyses (exclusion of cross-sectional studies, restriction to large-sample studies, use of unadjusted estimates, and leave-one-out procedures) were conducted to assess robustness. Publication bias was evaluated using funnel plots, trim-and-fill analysis, and Egger's regression test. Additional analyses included meta-regression to explore sources of heterogeneity, cumulative meta-analysis to assess temporal trends, and conversion of relative effects to absolute risk estimates. Results: = 99%). Subgroup analyses demonstrated consistent findings across study designs, age groups, and analytical approaches. Sensitivity analyses indicated stable results, with no single study markedly influencing the pooled estimate. Meta-regression suggested that study design, age group, and sample size explained part of the heterogeneity. Cumulative analysis showed that early small-sample studies overestimated the association, while larger recent studies stabilized the effect at 2-3 fold risk. Absolute effect estimates indicated an excess of 23-82 migraine cases per 1,000 individuals with AR, with population attributable fractions ranging from 6.8 to 18.1%. Conclusion: Allergic rhinitis is significantly associated with an increased risk of migraine. Clinicians should be aware of this association and consider integrated management strategies for patients with comorbid AR and migraine. Systematic review registration: INPLASY2025110052.