Neurological Sciences

, Volume 29, Supplement 1, pp 99–102 | Cite as

Towards a definition of comorbidity in the light of clinical complexity

  • Vincenzo Bonavita
  • Roberto De Simone
Key Note Lecture


Clinical complexity encompasses multiple levels, including all the disorders and conditions experienced by a person along cross-sectional and longitudinal contexts, the diversity of severity levels and courses of clinical conditions, but also the plurality of values of people experiencing health problems and seeking help for them. The term comorbidity refers to the association of two distinct diseases in the same individual at a rate higher than expected by chance. Looking systematically to comorbidity represents the main road to approach patients’ clinical complexity. Once epidemiologically established through population or community surveys, the study of the comorbidity direction and of the chronological patterns of associated clinical entities may offer relevant information from both a clinical and a scientific point of view. Comorbidity profiles of migraine and tension-type headache offer a paradigmatic example to appraise and highlight headache patient clinical complexity, allowing the conversion of diagnosis from a validated cluster of symptoms to a person-centred clinical diagnosis.


Comorbidity Migraine Tension-type headache Person-centred diagnosis Clinical complexity 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Feinstein AR (1967) Clinical judgment. Williams and Wilkins, BaltimoreGoogle Scholar
  2. 2.
    Lipton RB, Silberstein SD (1994) Why study the comorbidity of migraine? Neurology 44[10 Suppl 7]:S4–S5PubMedGoogle Scholar
  3. 3.
    Mezzich JE, Salloum IM (2008) Clinical complexity and person-centered integrative diagnosis. World Psychiatry 7:1–2PubMedGoogle Scholar
  4. 4.
    Mezzich JE (2007) Psychiatry for the person: articulating medicine’s science and humanism. World Psychiatry 6:65–67PubMedGoogle Scholar
  5. 5.
    Berkson J (1946) Limitation of the application of fourfold table analysis to hospital data. Biometrics Bulletin 2:47–53CrossRefGoogle Scholar
  6. 6.
    Merikangas KR, Merikangas JR, Angst J (1993) Headache syndromes and psychiatric disorders: association and familial transmission. J Psychiatr Res 27:197–210PubMedCrossRefGoogle Scholar
  7. 7.
    Puca F, Genco S, Prudenzano MP et al (1999) Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy. The Italian Collaborative Group for the Study of Psychopathological Factors in Primary Headaches. Cephalalgia 19:159–164PubMedCrossRefGoogle Scholar
  8. 8.
    Gabrielli M, Cremonini F, Fiore G et al (2003) Association between migraine and celiac disease: results from a preliminary case-control and therapeutic study. Am J Gastroenterol 98:625–629PubMedCrossRefGoogle Scholar
  9. 9.
    Borgna-Pignatti C, Fiumana E, Milani M et al (2004) Celiac disease in children with migraine. Pediatrics 114:1371PubMedCrossRefGoogle Scholar
  10. 10.
    Lipton RB, Ottman R, Ehrenberg BL, Hauser WA (1994) Comorbidity of migraine: the connection between migraine and epilepsy. Neurology 44[10 Suppl 7]:S28–S32PubMedGoogle Scholar
  11. 11.
    Yamane LE, Montenegro MA, Guerreiro MM (2004) Comorbidity headache and epilepsy in childhood. Neuropediatrics 35:99–102PubMedCrossRefGoogle Scholar
  12. 12.
    Tietjen GE, Brandes JL, Digre KB et al (2007) High prevalence of somatic symptoms and depression in women with disabling chronic headache. Neurology 68:134–140PubMedCrossRefGoogle Scholar
  13. 13.
    Schankin CJ, Ferrari U, Reinisch VM et al (2007) Characteristics of brain tumour-associated headache. Cephalalgia 27:904–911PubMedCrossRefGoogle Scholar
  14. 14.
    Bendtsen L, Jensen R (2006) Tension-type headache: the most common, but also the most neglected, headache disorder. Curr Opin Neurol 19:305–309PubMedGoogle Scholar
  15. 15.
    Mongini F, Rota E, Deregibus A et al (2006) Accompanying symptoms and psychiatric comorbidity in migraine and tensiontype headache patients. J Psychosom Res 61:447–451PubMedCrossRefGoogle Scholar
  16. 16.
    Janke EA, Holroyd KA, Romanek K (2004) Depression increases onset of tension type headache following laboratory stress. Pain 111:230–238PubMedCrossRefGoogle Scholar
  17. 17.
    Bousser MG, Welch KM (2005) Relation between migraine and stroke. Lancet Neurol 4:533–542PubMedCrossRefGoogle Scholar
  18. 18.
    De Simone R, Ranieri A, Marano E et al (2007) Migraine and epilepsy: clinical and pathophysiological relations. Neurol Sci 28[Suppl 2]:S150–S155PubMedCrossRefGoogle Scholar
  19. 19.
    Pietrini U, De Luca M, De Santis G (2005) Hypertension in headache patients? A clinical study. Acta Neurol Scand 112:259–264PubMedCrossRefGoogle Scholar
  20. 20.
    Prudenzano MP, Monetti C, Merico L et al (2005) The comorbidity of migraine and hypertension. A study in a tertiary care headache centre. J Headache Pain 6:220–222PubMedCrossRefGoogle Scholar
  21. 21.
    Diener HC, Kurth T, Dodick D (2007) Patent foramen ovale, stroke, and cardiovascular disease in migraine. Curr Opin Neurol 20:310–319PubMedCrossRefGoogle Scholar
  22. 22.
    Teixeira AL Jr, Meira FC, Maia DP et al (2005) Migraine headache in patients with Sydenham’s chorea. Cephalalgia 25:542–544PubMedCrossRefGoogle Scholar
  23. 23.
    Kwak C, Vuong KD, Jankovic J (2003) Migraine headache in patients with Tourette syndrome. Arch Neurol 60:1595–1598PubMedCrossRefGoogle Scholar
  24. 24.
    Biary N, Koller W, Langenberg P (1990) Correlation between essential tremor and migraine headache. J Neurol Neurosurg Psychiatry 53:1060–1062PubMedCrossRefGoogle Scholar
  25. 25.
    Tunca A, Turkay C, Tekin O et al (2004) Is Helicobacter pylori infection a risk factor for migraine? A case-control study. Acta Neurol Belg 104:161–164PubMedGoogle Scholar
  26. 26.
    Weder-Cisneros ND, Tellez-Zenteno JF, Cardiel MH et al (2004) Prevalence and factors associated with headache in patients with systemic lupus erythematosus. Cephalalgia 24:1031–1044PubMedCrossRefGoogle Scholar
  27. 27.
    Hottenga JJ, Vanmolkot KR, Kors EE et al (2005) The 3p21.1-p21.3 hereditary vascular retinopathy locus increases the risk for Raynaud’s phenomenon and migraine. Cephalalgia 25:1168–1172PubMedCrossRefGoogle Scholar
  28. 28.
    Low NC, Merikangas KR (2003) The comorbidity of migraine. CNS Spectr 8:433–434, 437–444PubMedGoogle Scholar
  29. 29.
    Bigal ME, Lipton RB (2006) Obesity is a risk factor for transformed migraine but not chronic tension-type headache. Neurology 67:252–257PubMedCrossRefGoogle Scholar
  30. 30.
    Versino M, Sances G, Anghileri E et al (2003) Dizziness and migraine: a causal relationship? Funct Neurol 18:97–101PubMedGoogle Scholar
  31. 31.
    Sen P, Georgalas C, Papesch MJ (2005) Co-morbidity of migraine and Meniere’s disease-is allergy the link? Laryngol Otol 119:455–460Google Scholar
  32. 32.
    Schmidtke K, Ehmsen L (1998) Transient global amnesia and migraine A case control study. Eur Neurol 40:9–14PubMedCrossRefGoogle Scholar
  33. 33.
    Knudsen S, Russell MB (2006) Increased risk of migraine in Marfan’s syndrome? Acta Neurol Scand 114:281–286PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  1. 1.Headache Centre Department of Neurological SciencesUniversity of Naples “Federico II”NaplesItaly
  2. 2.Istituto di Diagnosi e Cura Hermitage CapodimonteNaplesItaly

Personalised recommendations