The presence of fibromyalgia may serve as a clinical sign of a more severe migraine, according to study results published in Neurological Research.

Previous studies have reported that fibromyalgia, which is common in patients with migraine, is associated with increased headache frequency, muscle tenderness, anxiety, and sleep problems. The goal of this study was to assess the impact of fibromyalgia in patients with migraine, as well as to study the characteristics of patients with comorbid fibromyalgia and migraine.

A total of 102 consecutive patients age 18 to 50 years (mean age, 33.9±9.6 years; 85% women) who met the International Headache Society criteria for migraine were enrolled in this study. Fibromyalgia, diagnosed based on the 1990 American College of Rheumatology classification criteria, was present in 31 patients (30.3%).

All participants completed self-report questionnaires to assess the impact of headache (with the Headache Impact Test), migraine-related disability (using the Migraine Disability Assessment Scale), presence and severity of depression (with the Beck Depression Inventory), severity of anxiety (with the Beck Anxiety Inventory), quality of life (using the 36-Item Short Form Survey), and fibromyalgia outcomes (with the Fibromyalgia Impact Questionnaire).

In this cohort, 92% of participants were diagnosed with episodic migraine and 8% had been diagnosed with chronic migraine. A total of 32 patients (31.3%) had migraine with aura. Fibromyalgia was found to be more common in patients with vs without aura (44% vs 24%, respectively; P =.047) and to be more common in women vs men with migraine (34% vs 7%, respectively; P =.031).

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Patients with migraine and comorbid fibromyalgia vs migraine only had greater headache frequency (P =.000) and migraine disease duration (P =.007) and higher scores on the Headache Impact Test (P =.041) and the Migraine Disability Assessment Scale (P =.002). Scores on the vitality and role-emotional domains of the 36-item Short Form Survey were worse in patients with migraine and comorbid fibromyalgia vs migraine alone.

Medication overuse headache was diagnosed in 22 patients (22%). In these patients, fibromyalgia was more common compared with patients without medication overuse headache (50% vs 25%, respectively; P=.024).

Fibromyalgia Impact Questionnaire scores were found to correlate positively with scores on the Headache Impact Test, Migraine Disability Assessment Scale, and headache frequency scores and to be negatively correlated with scores on the vitality and role-emotional domains of 36-item Short Form Survey.

“These results strongly suggest comorbidity of [fibromyalgia] as a marker of a more severe migraine disease and worse psychiatric status. On the other hand, the prognoses and treatment outcomes of these [patients with migraine and fibromyalgia] comorbidity was not investigated in our study,” concluded the researchers.

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Reference

Onder H, Hamamci M, Alpua M, Ulusoy EK. Comorbid fibromyalgia in migraine patients: clinical significance and impact on daily life (published online June 20, 2019). Neurol Res. doi:10.1080/01616412.2019.1630164