Comorbidity More Likely With Chronic Migraine vs Episodic Migraine

Man with neck pain
Man with neck pain
Researchers deployed a survey to determine the extent of pain, psychiatric, endocrine, and neurologic comorbidities in patients with chronic or episodic migraine.
The following article is part of conference coverage from the 2018 American Academy of Neurology Annual Meeting in Los Angeles, California. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAN 2018.

LOS ANGELES — More patients with chronic migraine (CM) report experiencing comorbid conditions or symptoms vs patients with episodic migraine (EM), according to research presented at the 70th annual American Academy of Neurology meeting, held April 21-27, 2018, in Los Angeles, California.

Using criteria modified from the third edition of the International Classification of Headache Disorders, beta version, people with CM and EM were identified in data from the online prospective baseline survey of the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. A Comorbidities/Endophenotypes section, which assessed 64 conditions and symptoms, was completed by the participants. Respondents were asked about their experience and official diagnosis of particular symptoms or conditions, and data on psychiatric, pain, endocrine, and neurologic comorbidities were reported.

The 16,763 available CaMEO respondents with migraine were sent the Comorbidities/Endophenotype module, 12,810 (76.4%; EM, 11,699 and CM, 1111) of whom provided valid responses. The EM and CM groups had similar mean age (41.3 vs 41.9 years), but participants in the CM group were more likely to be female (74.2% vs 81.5%; P<.001) and white (84.0% vs 88.7%; P<.001). Compared with the EM group, participants in the CM group also had a higher mean body mass index (27.7 kg/m2 vs 28.7 kg/m2; P<.001). The CM patients had significantly higher relative frequencies of 87.5% (24/28) of the symptoms and conditions assessed. Compared with EM, 5 conditions had >10% higher relative frequencies in CM: chronic pain (7.4% vs 22.2%), chronic back pain (22.5% vs 37.6%), anxiety (25.7% vs 42.2%), depression (28.1% vs 45.6%), and neck pain (38.1% vs 55.3%).

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The study investigators were able to determine that significantly more patients with CM reported specific symptoms or conditions compared with patients with EM. They state that “Mechanisms explaining this association might include direct causality (eg, CM causes the comorbidity), reverse causality (eg, the condition increases CM risk), and shared genetic or environmental risk factors. Confounding, or detection bias (ie, ‘Berkson’s Bias’) could also contribute.”

The study was supported by Allergan.

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Adams AM, Lipton RB, Martin VT, et al. The relationship between pain, psychiatric, and endocrine/neurological comorbidities of migraine: results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Presented at: 2018 American Academy of Neurology Annual Meeting. April 21-27, 2018; Los Angeles, CA. Poster 124.