Comorbidities of Migraine and Their Impact on Pain Frequency and Intensity

Comorbidities of Migraine

According to data from 2016, migraine is the second most common disabling disease worldwide. It often occurs alongside associated diseases — and some more frequently than would be expected by chance (comorbidities). Understanding these comorbidities is important for several reasons. Firstly, the symptoms of migraine and associated diseases can overlap, and it is therefore necessary to consider comorbidities in the differential diagnostic process. Knowledge of comorbidities is also crucial when selecting appropriate therapy. The mutual influence of concurrent diseases is also noteworthy. Some comorbidities are linked to a higher risk of chronic migraine. Lastly, associated diseases can reduce overall quality of life and increase economic burden.

The most significant comorbidities of migraine include:

• Cardiovascular diseases (stroke, myocardial infarction)
• Psychiatric diseases (depression, anxiety, panic disorder, personality disorders, suicidal tendencies, bipolar disorder)
• Neurological diseases and sleep disorders (epilepsy, insomnia, restless legs syndrome, sleep apnea)
• Allergic rhinitis, asthma
• Fibromyalgia

As can be seen, migraine has many supposed comorbidities, but the occurrence of associated diseases has rarely been compared with a population sample that does not suffer from migraine. The MAST study also examined the relationship between comorbidities and the frequency and intensity of pain.

Study Methodology and Evaluated Population

The aim of the prospective MAST study was to evaluate the prevalence of individual diseases and the presence and parameters of migraine in a representative sample of the US population. Data collection was done via an online questionnaire. The modified ICHD-3 (International Classification of Headache Disorders 3 beta criteria) was used to identify individuals with migraine.

The study included a total of 15,133 patients suffering from migraine (73% women, average age 43 years) and 77,453 controls (46.4% women, average age 52 years).

Findings

Patients suffering from migraine showed a significant difference in the frequency of insomnia (odds ratio [OR] 3.79; 95% confidence interval [CI] 3.6–4.0), depression (OR 3.18; 95% CI 3.0–3.3), anxiety (OR 3.18; 95% CI 3.0–3.3), and gastric ulcers/gastrointestinal bleeding (OR 3.11; 95% CI 2.8–3.5). These comorbidities occurred more than three times more frequently in migraine patients compared to controls.

There was also a significant difference in frequency for peripheral artery disease (OR 2.69; 95% CI 2.3–3.1), angina pectoris (OR 2.64; 95% CI 2.4–3.0), allergies/hay fever (OR 2.49; 95% CI 2.4–2.6), epilepsy (OR 2.33; 95% CI 2.0–2.8), unspecified arthritis (OR 2.20; 95% CI 2.1–2.4), stroke or transient ischemic attack (OR 2.18; 95% CI 1.9–2.5), rheumatoid arthritis (OR 2.11; 95% CI 1.9–2.4), asthma (OR 2.03; 95% CI 1.9–2.1), and vitamin D deficiency (OR 2.00; 95% CI 1.9–2.1). These comorbidities occurred at least twice as often in migraine patients compared to controls.

Other, less common comorbidities included psoriasis, osteoarthritis, rosacea, myocardial infarction, hypercholesterolemia, arterial hypertension, kidney disease, and diabetes.

Higher headache intensity was observed in patients with inflammatory comorbidities (psoriasis, allergies), psychiatric diseases (depression, anxiety), and sleep disorders (insomnia). Higher frequency of migraine headaches was associated with nearly all identified comorbidities, particularly gastric ulcers/gastrointestinal bleeding, diabetes, anxiety, depression, insomnia, asthma, and allergies/hay fever.

Conclusion

In this extensive study of a representative USA population sample, all monitored diseases were more common in patients with migraine headaches. Higher frequency of migraine attacks and pain intensity was associated with most evaluated comorbidities. However, a causal relationship remains unclear.

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Source: Buse D. C., Reed M. L., Fanning K. M. et al. Comorbid and co-occurring conditions in migraine and associated risk of increasing headache pain intensity and headache frequency: results of the migraine in America symptoms and treatment (MAST) study. J Headache Pain 2020; 21 (1): 23, doi: 10.1186/s10194-020-1084-y.