Prurigo nodularis (PN) is a chronic skin disorder characterized by intensely pruritic nodular lesions. Migraines are a common neurological disorder characterized by episodic headaches and sensory disturbances. A potential link between PN and migraines is supported by their involvement in neuroimmune signaling that includes CGRP activity, cytokine signaling, and central sensitization.  PN has been associated with neurologic and psychiatric comorbidities, but no study has quantified the migraine risk in this population.

We conducted a retrospective cohort study using the TriNetX US Collaborative Network. Adults diagnosed with PN were matched 1:1 to controls without PN based on age, sex, and depression. Patients with a history of migraine, anti-migraine medications, or use of dupilumab and nemolizumab were excluded. Incident migraine diagnoses and subtypes (without aura, with aura, unspecified) were tracked from one day up to one year and five years post-index. Hazard ratios (HR) and incidence percentages were reported.

A total of 69,632 patients were included in each cohort. At one year, PN patients had a higher incidence of any migraine diagnosis (2.5% vs. 1.0%; HR 2.39, p < 0.001). At five years, incidence increased to 5.2% vs. 2.6% (HR 2.08, p < 0.001). Subtype-specific five-year analyses showed increased risk for migraine diagnosis without aura (1.5% vs. 0.6%; HR 2.93), with aura (1.2% vs. 0.6%; HR 2.34), and unspecified migraine (2.9% vs. 1.4%; HR 2.24), all p < 0.001.

Patients with prurigo nodularis have an increased risk of developing migraines. These findings support neurologic screening in PN management and encourage collaboration between dermatologists and neurologists to improve recognition and care of neurologic comorbidities.