Migraine headaches in chronic fatigue syndrome (CFS): comparison of two prospective cross-sectional studies

Murugan K Ravindran, Yin Zheng, Christian Timbol, Samantha J Merck, James N Baraniuk, Murugan K Ravindran, Yin Zheng, Christian Timbol, Samantha J Merck, James N Baraniuk

Abstract

Background: Headaches are more frequent in Chronic Fatigue Syndrome (CFS) than healthy control (HC) subjects. The 2004 International Headache Society (IHS) criteria were used to define CFS headache phenotypes.

Methods: Subjects in Cohort 1 (HC = 368; CFS = 203) completed questionnaires about many diverse symptoms by giving nominal (yes/no) answers. Cohort 2 (HC = 21; CFS = 67) had more focused evaluations. They scored symptom severities on 0 to 4 anchored ordinal scales, and had structured headache evaluations. All subjects had history and physical examinations; assessments for exclusion criteria; questionnaires about CFS related symptoms (0 to 4 scale), Multidimensional Fatigue Inventory (MFI) and Medical Outcome Survey Short Form 36 (MOS SF-36).

Results: Demographics, trends for the number of diffuse "functional" symptoms present, and severity of CFS case designation criteria symptoms were equivalent between CFS subjects in Cohorts 1 and 2. HC had significantly fewer symptoms, lower MFI and higher SF-36 domain scores than CFS in both cohorts. Migraine headaches were found in 84%, and tension-type headaches in 81% of Cohort 2 CFS. This compared to 5% and 45%, respectively, in HC. The CFS group had migraine without aura (60%; MO; CFS+MO), with aura (24%; CFS+MA), tension headaches only (12%), or no headaches (4%). Co-morbid tension and migraine headaches were found in 67% of CFS. CFS+MA had higher severity scores than CFS+MO for the sum of scores for poor memory, dizziness, balance, and numbness ("Neuro-construct", p = 0.002) and perceived heart rhythm disturbances, palpitations and noncardiac chest pain ("Cardio-construct"; p = 0.045, t-tests after Bonferroni corrections). CFS+MO subjects had lower pressure-induced pain thresholds (2.36 kg [1.95-2.78; 95% C.I.] n = 40) and a higher prevalence of fibromyalgia (47%; 1990 criteria) compared to HC (5.23 kg [3.95-6.52] n = 20; and 0%, respectively). Sumatriptan was beneficial for 13 out of 14 newly diagnosed CFS migraine subjects.

Conclusions: CFS subjects had higher prevalences of MO and MA than HC, suggesting that mechanisms of migraine pathogenesis such as central sensitization may contribute to CFS pathophysiology.

Clinical trial registration: Georgetown University IRB # 2006-481

Trial registration: ClinicalTrials.gov NCT00810329.

Figures

Figure 1
Figure 1
CFS symptom severity scores for Cohort 2. Symptom severities were scored on ordinal scales from 0 to 4. HC (red columns) had significantly lower scores for each item (mean; 95% C.I. error bars) compared to all CFS (yellow columns) (p ≤ 0.006 after Bonferonni corrections). HC scores were also significantly lower than all the CFS headache subtypes and items except sore throat in CFS+T (green bar). CFS+MA (blue columns) had significantly higher scores than CFS+T for exertional exhaustion (p = 0.036) and sore lymph nodes (p = 0.017).

References

    1. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. the International Chronic Fatigue Syndrome Study Group. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med. 1994;121:953–959.
    1. Peres MFP, Zukerman E, Young WB, Silberstein SD. Fatigue in chronic migraine patients. Cephalagia. 2002;22:720–724. doi: 10.1046/j.1468-2982.2002.00426.x.
    1. Headache Classification Subcommittee of the International Headache Society. Cephalalgia. 2. Suppl 1. Vol. 24. 2004. The International Classification of Headache Disorders; pp. 9–160.
    1. Baraniuk JN, Clauw JD, Gaumond E. Rhinitis symptoms in chronic fatigue syndrome. Annals Allergy Asthma Immunol. 1998;81:359–365. doi: 10.1016/S1081-1206(10)63129-8.
    1. Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39:315–325. doi: 10.1016/0022-3999(94)00125-O.
    1. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care. 1995;30:473–483. doi: 10.1097/00005650-199206000-00002.
    1. Melzack R. The short-form McGill pain questionnaire. Pain. 1987;30:191–197. doi: 10.1016/0304-3959(87)91074-8.
    1. Wolfe F, Smythe H, Yunus M, Bennett R, Bombardier C, Goldenberg D. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis and Rheumatism. 1990;33:160–172. doi: 10.1002/art.1780330203.
    1. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 2010;62:600–610. doi: 10.1002/acr.20140.
    1. Robbins M, Lipton RB. The epidemiology of primary headache disorders. Semin Neurol. 2010;30:107–119. doi: 10.1055/s-0030-1249220.
    1. Ravindran M, Baraniuk JN. The sinus headache explained. Curr Allergy Asthma Rep. 2010;10:202–209. doi: 10.1007/s11882-010-0095-1.
    1. Kelman L. The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs. Headache. 2004;44:865–872. doi: 10.1111/j.1526-4610.2004.04168.x.
    1. Stephen D. Atlas of Migraine and Other Headaches. London: Taylor & Francis Group; 2005.
    1. Eikermann-Haerter K, Ayata C. Cortical spreading depression and migraine. Curr Neurol Neurosci Rep. 2010;10:167–173. doi: 10.1007/s11910-010-0099-1.
    1. Okifuji A, Turk DC, Marcus DA. Comparison of generalized and localized hyperalgesia in patients with recurrent headache and fibromyalgia. Psychosom Med. 1999;61:771–780.
    1. Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10:895–926. doi: 10.1016/j.jpain.2009.06.012.
    1. Wasserfallen JB, Gold K, Schulman KA, Milzman D, Baraniuk JN. Development and validation of a rhinoconjunctivitis and asthma symptom score for use as an outcome measure in clinical trials. J Allergy Clin Immunol. 1997;100:16–22. doi: 10.1016/S0091-6749(97)70189-1.
    1. Naranch K, Park YJ, Repka-Ramirez MS, Velarde A, Clauw D, Baraniuk JN. A tender sinus does not always mean rhinosinusitis. Otolaryngol Head Neck Surg. 2002;127:387–397. doi: 10.1067/mhn.2002.129038.
    1. Swinscow TDV, Campbell MJ. Statistics at Square One. BMJ Books, London. 2002. pp. 44–51.
    1. Gardner MJ, Altman DG, eds. Statistics With Confidence - Confidence intervals and statistical guidelines. BMJ. London. 1989. pp. 1–140.
    1. Tietjen GE, Brandes JL, Peterlin BL, Eloff A, Dafer RM, Stein MR, Drexler E, Martin VT, Hutchinson S, Aurora SK, Recober A, Herial NA, Utley C, White L, Khuder SA. Allodynia in migraine: association with comorbid pain conditions. Headache. 2009;49:1333–1344. doi: 10.1111/j.1526-4610.2009.01521.x.
    1. de Tommaso M, Sardaro M, Serpino C, Costantini F, Vecchio E, Prudenzano MP, Lamberti P, Livrea P. Fibromyalgia comorbidity in primary headaches. Cephalalgia. 2009;29:453–464. doi: 10.1111/j.1468-2982.2008.01754.x.
    1. Ménière P. Pathologie auriculaire. Mémoires sur une lésion de 1'oreille interne donnant lieu à des symptoms de congestion cérébrale apoplectiforme. Gaz Med Paris. 1861;16:597–601.
    1. Neuhauser H, Lempert T. Vertigo and dizziness related to migraine: a diagnostic challenge. Cephalalgia. 2004;24:83–91. doi: 10.1111/j.1468-2982.2004.00662.x.
    1. Tak LM, Riese H, de Bock GH, Manoharan A, Kok IC, Rosmalen JG. As good as it gets? A meta-analysis and systematic review of methodological quality of heart rate variability studies in functional somatic disorders. Biol Psychol. 2009;82:101–110. doi: 10.1016/j.biopsycho.2009.05.002.
    1. Frissora CL, Koch KL. Symptom overlap and comorbidity of irritable bowel syndrome with other conditions. Curr Gastroenterol Rep. 2005;Aug:264–271. doi: 10.1007/s11894-005-0018-9.
    1. Wise CM, Semble EL, Dalton CB. Musculoskeletal chest wall syndromes in patients with noncardiac chest pain: a study of 100 patients. Arch Phys Med Rehabil. 1992;73:147–149.
    1. Fukui PT, Gonçalves TR, Strabelli CG, Lucchino NM, Matos FC, Santos JP, Zukerman E, Zukerman-Guendler V, Mercante JP, Masruha MR, Vieira DS, Peres MF. Trigger factors in migraine patients. Arq Neuropsiquiatr. 2008;66:494–499.
    1. Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many? Lancet. 1999;354:936–939. doi: 10.1016/S0140-6736(98)08320-2.
    1. Fink P, Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res. 2010;68:415–426. doi: 10.1016/j.jpsychores.2010.02.004.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj