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Published on: June 2, 2014
Comorbid pain and migraine chronicity: The Chronic Migraine Epidemiology and Outcomes Study
Ann I Scher1, Dawn C Buse1, Kristina M Fanning1
1From the Department of Neurology (D.C.B., R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center (D.C.B., R.B.L.), Bronx, NY; Vedanta Research (K.M.F.), Chapel Hill, NC; Complete Healthcare Communications (A.M.K., D.A.F.), Chadds Ford, PA; Allergan plc (A.M.A.), Irvine, CA. affiliated with the Department of Preventive Medicine and Biometrics (A.I.S.), Uniformed Services University of the Health Sciences, Bethesda, MD.
Objective:
To identify patterns of noncephalic pain comorbidity in people with episodic migraine (EM; <15 headache-days per month) and chronic migraine (CM; ≥15 headache-days per month) and to examine whether the presence of noncephalic pain is an indicator for the 3-month onset or persistence of CM.
Methods:
Data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a prospective, web-based study with cross-sectional modules embedded in a longitudinal design, were analyzed at baseline and the 3-month follow-up. Relationships between the number of noncephalic pain sites and 3-month onset of CM or persistent CM were assessed.
Results:
Of 8,908 eligible respondents, 8,139 (91.4%) had EM and 769 (8.6%) had CM at baseline. At 3 months, the incidence of CM among those with baseline EM was 3.4%. When adjusted for demographics and headache-day frequency, the odds of CM onset among those with baseline EM increased by 30% (95% confidence interval [CI] 1.21-1.40, p < 0.001) for each additional noncephalic pain site at baseline. Among those with CM at baseline, 50.1% had persistent CM at the 3-month follow-up. After adjustment for demographics, individuals with CM were 15% (95% CI 1.07-1.25, p < 0.001) more likely to have persistent CM for each additional noncephalic pain site at baseline.
Conclusions:
These results suggest that noncephalic pain may be a marker for headache chronicity that could be used to identify people with EM at risk of the onset of CM and people with CM at risk of persistent CM.
Insights
The presence of pain beyond the head may indicate a higher risk for developing chronic migraine (CM) or persistent CM. This finding can help identify individuals with episodic migraine at risk for CM onset.
Area of Science:
- Neurology
- Epidemiology
Background:
- Migraine is a common neurological disorder.
- Noncephalic pain comorbidity is frequently observed in migraine patients.
- Understanding the relationship between noncephalic pain and migraine chronification is crucial.
Purpose of the Study:
- To investigate patterns of noncephalic pain in episodic migraine (EM) and chronic migraine (CM).
- To determine if noncephalic pain predicts the onset or persistence of CM over 3 months.
Main Methods:
- Analysis of data from the prospective, web-based Chronic Migraine Epidemiology and Outcomes (CaMEO) Study.
- Assessment of relationships between the number of noncephalic pain sites and 3-month CM onset or persistence.
Main Results:
- At baseline, 91.4% of 8,908 respondents had EM and 8.6% had CM.
- Each additional noncephalic pain site increased the odds of CM onset in EM patients by 30% (p < 0.001).
- Each additional noncephalic pain site increased the odds of persistent CM in CM patients by 15% (p < 0.001).
Conclusions:
- Noncephalic pain serves as a potential marker for headache chronicity.
- Identifying noncephalic pain can help flag individuals with EM at risk for CM onset.
- It can also identify individuals with CM at risk for persistent disease.
