How Do Migraines Plus Body Pain Differ From Migraines Alone?

Although pain is the most recognizable feature associated with migraines, many migraineurs also experience fatigue and decreased levels of physical activity. Moreover, many persons with migraines also experience significant comorbid pain elsewhere in the body, which presents diagnostic and treatment challenges.

Scant research has illuminated whether and how persons with migraine pain and comorbid noncephalic pain differ from those with migraine alone. Results of previous research have shown that noncephalic pain is a risk factor for progression to episodic migraine and then to chronic migraine, suggesting that such persons may be biologically predisposed to developing pain chronicity.

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Accordingly, researchers at Stanford University in California used the Patient‐Reported Outcomes Measurement System (PROMIS), a set of validated patient‐centered measures that evaluates physical, mental, and social health, to compare the characteristics of patients with migraine alone compared with patients with migraines and comorbid noncephalic pain in order to better understand and meet the unique needs of those in the latter group.

The researchers analyzed data from the Collaborative Health Outcomes Information Registry (CHOIR) for approximately 500 patients with chronic migraine and 1200 patients with chronic migraine and comorbid bodily pain. They undertook cross‐sectional analyses comparing the 2 groups’ PROMIS scores, including for correlations between the number of noncephalic pain regions.

The results showed that patients with chronic migraine and other bodily pain had statistically significantly worse PROMIS scores in almost every category, such as pain interference, physical function, sleep impairment, anxiety, depression, fatigue, and pain catastrophizing. The authors noted that additional statistically significant correlations between the number of nonheadache body regions and worse physical function, sleep disturbance, and fatigue.

The authors concluded that patients with migraine and other body pain not only had decreased physical function, but also poorer sleep and increased fatigue. They state that these findings “may point to [an] underlying systemic process compared to isolated chronic migraine and [support] prior research suggesting a possible underlying predisposition to developing pain chronicity.” They also note that these patients may need more personalized interventions to address physical and mental health than patients with chronic migraine without other bodily pain.

The study’s findings were presented at the 60th Annual Scientific Meeting of the American Headache Society, held June 28 through July 1, 2018, in San Francisco. The abstract was published in the journal Headache on June 27.

—Michael Gerchufsky

Reference:

Aggarwal A, Barad M, Sturgeon D, Mackey S. Characterizing patients with migraines compared to patients with co‐morbid non‐cephalic pain [American Headache Society Annual Scientific Meeting abstract PF28]. Headache. 2018;58(suppl 2):94-95. https://onlinelibrary.wiley.com/doi/full/10.1111/head.13306. Accessed July 5, 2018.