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Episodic Migraine Comorbidities: Avoiding Pitfalls and Taking Therapeutic Opportunities

Current Pain and Headache Reports volume 23, Article number: 1 (2019) Cite this article

Abstract

Migraine is a common neurologic disorder. This article will discuss a few factors that influence migraine (mostly episodic) and its treatment, such as sleep, obstructive sleep apnea (OSA), obesity, and affective disorders, as well as autoimmune diseases. Practitioners must be aware of these coexisting conditions (comorbidities) as they affect treatment. It is noted in literature that both the quantity (too much or too few hours) and the quality (OSA related) of sleep may worsen migraine frequency. An associated risk factor for OSA, obesity also increases migraine frequency in episodic migraine cases. A bidirectional relationship with migraine along with depression and anxiety is debated in the literature. Retrospective cohort studies are undecided and lack statistical significance, but prospective studies do show promising results on treatment of anxiety and depression as a means of improving migraine control. Finally, we address the topic of autoimmune diseases and migraine. While few studies exist at this time, there are cohort study groups looking into the association between rheumatoid arthritis, hypothyroidism, and antiphospholipid antibody. There is also evidence for the link between migraine and vascular diseases, including coronary and cerebral diseases. We suggest that these comorbid conditions be taken into account and individualized for each patient along with their pharmaceutical regimen. Physicians should seek a multifactorial treatment plan including diet, exercise, and healthy living to reduce migraine frequency.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. •• Manack A, Turkel C, Silberstein S. The evolution of chronic migraine: classification and nomenclature. Headache. 2009;49:1206–13.

    Article  PubMed  Google Scholar 

  2. •• Adams AM, Serrano D, Buse DC, et al. The impact of chronic migraine: the Chronic Migraine Epidemiology and Outcomes (CAMEO) Study methods and baseline results. Cephalalgia. 2015;35(7):563–78.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Blau JN. Resolution of migraine attacks: sleep and the recovery phase. J Neurol Neurosurg Psychiatry. 1982;45:223–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Kelman L, Rains JC. Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache. 2005;45:904–10.

    Article  PubMed  Google Scholar 

  5. Fox AW, Davis RL. Migraine chronobiology. Headache. 1998;38:436–41.

    Article  CAS  PubMed  Google Scholar 

  6. Dodick DW, Eross EJ, Parish JM, Silber M. Clinical, anatomical, and physiologic relationship between sleep and headache. Headache. 2003;43(3):282–92.

    Article  PubMed  Google Scholar 

  7. Barbanti P, Fabbrini G, Aurilia C, Vanacore N, Cruccu G. A case-control study on excessive daytime sleepiness in episodic migraine. Cephalalgia. 2007;27:1115–9.

    Article  CAS  PubMed  Google Scholar 

  8. Sancisi E, Cevoli S, Vignatelli L, Nicodemo M, Pierangeli G, Zanigni S, et al. Increased prevalence of sleep disorders in chronic headache: a case-control study. Headache. 2010;50(9):1464–72.

    Article  PubMed  Google Scholar 

  9. Johnson KG, Zimeba AM, Garb JL. Improvement in headaches with continuous positive airway pressure for obstructive sleep apnea: a retrospective analysis. Headache. 2013;53(2):333–43.

    Article  PubMed  Google Scholar 

  10. Calhoun AH, Ford S. Behavioral sleep modification may revert transformed migraine to episodic migraine. Headache. 2007;47:1178–83.

    Article  PubMed  Google Scholar 

  11. Rains JC, Poceta JS. Headache and sleep disorders: review and clinical implications for headache management. Headache. 2006;46(9):1344–63.

    Article  PubMed  Google Scholar 

  12. Winter AC, Schürks M, Berger K, Buring JE, Gaziano JM, Kurth T. Migraine and restless legs syndrome in men. Cephalalgia. 2013;33:130–5.

    Article  PubMed  Google Scholar 

  13. Kanki R, Takeshima T. Restless legs syndrome as a comorbidity of migraine. Cephalalgia. 2011;31(Suppl 1):160.

    Google Scholar 

  14. Lin G-Y, Lin Y-K, Lee J-T, Lee MS, Lin CC, Tsai CK, et al. Prevalence of restless legs syndrome in migraine patients with and without aura: a cross-sectional, case-controlled study. J Headache Pain. 2016;17(1):97.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Cannon PR, Larner AJ. Migraine and restless legs syndrome: is there an association? J Headache Pain. 2011;12(4):405–9.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Cologno D, Cicarelli G, Petretta V, d’Onofrio F, Bussone G. High prevalence of dopaminergic premonitory symptoms in migraine patients with restless legs syndrome: a pathogenetic link? Neurol Sci. 2008;29(Suppl 1):S166–8.

    Article  PubMed  Google Scholar 

  17. WHO. Obesity-preventing and managing the global epidemic. report of WHO Consultation on Obesity. Geneva: World Health Organization; 1997.

    Google Scholar 

  18. Evans RW, Williams MA, Rapoport AM, Peterlin BL. The association of obesity with episodic and chronic migraine. Headache. 2012;52(4):663–71.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Vo M, Ainalem A, Qiu C, Peterlin BL, Aurora SK, Williams MA. Body mass index and adult weight gain among reproductive age women with migraine. Headache. 2011;51:559–69.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Bigal ME, Lipton RB. Obesity is a risk factor for transformed migraine but not chronic tension-type headache. Neurology. 2006;67:252–7.

    Article  PubMed  Google Scholar 

  21. Robberstad L, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart JA. An unfavorable lifestyle and recurrent headaches among adolescents: the HUNT study. Neurology. 2010;75:712–7.

    Article  CAS  PubMed  Google Scholar 

  22. Varkey E, Cider A, Carlsson J, Linde M. Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controls. Cephalalgia. 2011;31:1428–38.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Young WB, Rozen TD. Preventive treatment of migraine: effect on weight. Cephalalgia. 2005;25:1–11.

    Article  CAS  PubMed  Google Scholar 

  24. Peterlin BL. Bariatric surgery in obese migraineurs: mounting evidence but important questions remain. Cephalalgia. 2011;31:1333–5.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Chu H, et al. Associations between depression/anxiety and headache frequency in migraineurs: a cross-sectional study. Headache. 2018;58(3):407–15.

    Article  PubMed  Google Scholar 

  26. Zarcone D, Corbetta S. Shared mechanisms of epilepsy, migraine and affective disorders. Neurol Sci. 2017;38:S73–6.

    Article  Google Scholar 

  27. Dikmen P, Yavuz B, Aydinlar E. The relationships between migraine, depression and anxiety and sleep disturbances. Acta Neurol Belg. 2015;115(2):117–22.

    Article  Google Scholar 

  28. Smitherman T, Kolivas E, Bailey J. Panic disorder and migraine: comorbidity, mechanisms, and clinical implications. Headache. 2013;53(1):23–45.

    Article  PubMed  Google Scholar 

  29. Novic A, Kolves K, O’Dwyer S, De Leo D. Migraine and suicidal behaviors a systematic literature review. Clin J Pain. 2016;32:351–64.

    Article  PubMed  Google Scholar 

  30. Frediani F, Villani V. Migraine and depression. Neurol Sci. 2007;28(Suppl 2):S161–5.

    Article  PubMed  Google Scholar 

  31. Merikangas K. Psychopathology and headache syndromes in the community. Headache. 1994;34:S17–26.

    Article  CAS  PubMed  Google Scholar 

  32. Juang K, Yang C-Y. Psychiatric comorbidity of chronic daily headache: focus on traumatic experiences in childhood, post-traumatic stress disorder and suicidality. Curr Pain Headache Rep. 2014;18:405.

    Article  PubMed  Google Scholar 

  33. Palacios-Cena M, et al. Women with chronic and episodic exhibit similar widespread pressure sensitivity. Pain Med. 2016;17(11):2127–33.

    Article  PubMed  Google Scholar 

  34. Mohseni N, Togha M, Arzaghi SM, Nekooie S, Tafti MF, Fatehi F. Personality trats and anxiety and depressive disorders in patients with medication-overuse headaches versus episodic migraine. Prim Care Companion CNS Disord. 2017;14:19(6).

  35. Ruscheweyh R, Müller M, Blum B, Straube A. Correlation of headache frequency and psychosocial impairment in migraine: a cross-sectional study. Headache. 2014;54(5):861–71.

    Article  PubMed  Google Scholar 

  36. Leo R, Singh J. Migraine headache and bipolar disorder comorbidity: a systematic review of the literature and clinical implications. Scand J Pain. 2016;11:136–45.

    Article  PubMed  Google Scholar 

  37. Huddleston C, Martin L, Woods K, Dindo L. One-day behavioral intervention for distressed veterans with migraine: results of a multimethod pilot study. Mil Med. 2018;183(7–8):e184–e192.

  38. Wag YC, Huang YP, Want MT, et al. Increased risk of rheumatoid arthritis in patients with migraine: a population-based, propensity score-matched cohort study. Rheumatol Int. 2017;37(2):273–9.

    Article  Google Scholar 

  39. Martin AT, Pinney SM, Xie C, Herrick RL, Bai Y, Buckholz J, et al. Headache disorders may be a risk factor for the development of new onset hypothyroidism. Headache. 2017;57(1):21–30.

    Article  PubMed  Google Scholar 

  40. Ekici B, Cebeci AN. The debate on the link between subclinical hypothyroidism and childhood migraine: is initial endocrinological evaluation necessary for children with migraine? Acta Neurol Belg. 2015;115(2):123–7.

    Article  PubMed  Google Scholar 

  41. Islam MA, Alam F, Wong KK. Cormorbid association of antiphospholipid antibodies and migraine: a systematic review and meta-analysis. Autoimmun Rev. 2017;16(5):512–22.

    Article  PubMed  Google Scholar 

  42. Sacco S, Kurth T. Migraine and the risk of stroke and cardiovascular disease. Curr Cardiol Rep. 2014;16:524.

    Article  PubMed  Google Scholar 

  43. Kurth T, Winter AC, Eliassen AH, et al. Migraine and risk of cardiovascular disease in women: prospective cohort study. BMJ. 2016;i2610:353.

    Google Scholar 

  44. O’Keeffe ST, Tsapatsaris NP, Beetham WP Jr. Association between Raynaud’s phenomenon and migraine in a random population of hospital employees. J Rheumatol. 1993 Jul;20(7):1187–8.

    PubMed  Google Scholar 

  45. Lau C, Lin C, Chen W, Wang H, Kao C. Association between migraine and irritable bowel syndrome: a population-based retrospective cohort study. Eur J Neurol. 2014;21:1198–204.

    Article  PubMed  Google Scholar 

  46. Faresjo A, Grodzinsky E, Hallert C, Timpka T. Patients with irritable bowel syndrome are more burdened by co-morbidity and worry about serious diseases than healthy controls- eight years follow-up of IBS patients in primary care. BMC Public Health. 2013;13:832.

    Article  PubMed Central  PubMed  Google Scholar 

  47. van Hemert S, Breedveld AC, Rovers JM, Vermeiden JP, Witteman BJ, Smits MG, et al. Migraine associated with gastrointestinal disorders: review of the literature and clinical implications. Front Neurol. 2014;5:241.

    PubMed  PubMed Central  Google Scholar 

  48. Aydinlar E, Dikmen P, Tiftikci A, Saruc M, Aksu M, Gunsoy H, et al. IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013;53:514–425.

    Article  PubMed  Google Scholar 

  49. Camara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A. Gastrointestinal disorders associated with migraine: a comprehensive review. World J Gastroenterol. 2016;22:8149–60.

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Mount Sinai Beth Israel, New York, NY, USA

    Britany Klenofsky & Huma U. Sheikh

  2. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Anna Pace, Lauren R. Natbony & Huma U. Sheikh

Authors
  1. Britany Klenofsky
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  4. Huma U. Sheikh
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Correspondence to Huma U. Sheikh.

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Britany Klenofsky, Anna Pace, Lauren Natbony, and Huma U. Sheikh declare no conflict of interest.

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This article is part of the Topical Collection on Episodic Migraine

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Klenofsky, B., Pace, A., Natbony, L.R. et al. Episodic Migraine Comorbidities: Avoiding Pitfalls and Taking Therapeutic Opportunities. Curr Pain Headache Rep 23, 1 (2019). https://doi.org/10.1007/s11916-019-0742-8

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  • DOI: https://doi.org/10.1007/s11916-019-0742-8

Keywords

  • Migraine
  • Sleep
  • Anxiety
  • Depression
  • Obesity