Patients with comorbid fibromyalgia and migraine vs migraine alone may experience more depressive symptoms, greater headache intensity, and be more likely to have severe headache-related disability, according to a study published in The Journal of Headache and Pain.

To evaluate previous reports that fibromyalgia intensifies the disabling effects and depressive symptoms of migraine, researchers conducted a retrospective cohort study using a headache database at the Mayo Clinic in Rochester, Minnesota. They identified 157 patients with comorbid fibromyalgia and migraine and 471 individuals with migraine only. Study participants were asked to evaluate headache intensity on a 10-point scale, depressive symptoms, using the Patient Health Questionnaire-9, and migraine-related disability using the Migraine Disability Assessment Scale (MIDAS). Baseline characteristics were similar in both groups.

On average, patients with comorbid fibromyalgia and migraine reported higher Patient Health Questionnaire-9 scores than patients with only migraine (odds ratio [OR], 1.08; P <.0001), and were more likely to score in a higher severity category on the PHQ-9 (odds ratio [OR], 1.467; P <.0001). Average headache intensity was higher in individuals with migraine comorbid with fibromyalgia vs migraine alone (OR, 1.15; P =.0065). Despite comparable total MIDAS scores, a higher percentage of study participants with comorbid fibromyalgia and migraine vs migraine alone scored a higher grade of migraine disability.

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The majority of study participants had chronic migraine, which is often associated with medication overuse, which was not accounted for in this study.

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 “It is important to inquire about comorbid fibromyalgia as this needs to be taken into consideration with regards to creating an optimal individualized treatment plan. On the basis of this study, it would be reasonable to screen for symptoms of fibromyalgia in patients [with migraine] when they report a number of depressive symptoms, severe headache intensity, or severe headache related disability,” concluded the study authors.

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Whealy M, Nanda S, Vincent A, Mandrekar, Cutrer FM. Fibromyalgia in migraine: a retrospective cohort study [published online July 31, 2018] J Headache Pain. doi:10.1186/s10194-018-0892-9