The comorbids

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Several chronic pain disorders were reported to be associated with migraine. The Nord-Trøndelag Health Study (Hagen et al., 2002) noted that subjects with headache reported more musculoskeletal pain than those without. The risk was similar between migraine and non-migraine headache patients (OR = 1.9 vs. 1.8). However, headache frequency was a strong predictor for musculoskeletal pain. Von Korff et al. (2005) also found that patients with self-reported chronic spine pain were associated with migraine with an OR of 5.2. Fibromyalgia was very common in patients with migraine with frequencies between 22 and 40%. (Peres et al., 2001; Ifergane et al., 2006; de Tommaso et al., 2009) The development of fibromyalgia was highly associated with migraine frequency. Patients who suffered from both migraine and fibromyalgia reported a higher prevalence of insomnia, lower quality of life and more mental stress (Peres et al., 2001; de Tommaso et al., 2009). It is interesting that the fibromyalgia was more frequent in female migraine patients than male patients (Ifergane et al., 2006; de Tommaso et al., 2009).

Fibromyalgia as you see is associated with higher frequency of migraines, higher prevalence of insomnia, lower quality of life and more mental stress. Therefore a comorbidity like this can have a major impact on coping with the migraines, with both. Certainly I have found this to be true. My frequency is daily, my insomnia severe and difficult to treat and both have impacted my quality of life and I do experience a great deal of stress due to the pain. Not to mention FM is chronic pain itself. I have been so insanely sore lately it is hard to sit down, hard to lay down for too long, hard to get up and walk… pain levels have been high. Add the migraines in and that is a whole lot of Overall pain we are talking about and Low level of functionality. There is times when the migraine is severe and I need to lie down… but I can’t lay down long because it causes me significant FM pain.


 In another study, which used data from an adult US population to look at the cross-sectional associations between three pain conditions (migraine, arthritis and back pain) and three psychiatric disorders [depression, generalized anxiety disorder (GAD) and panic attacks] (McWilliams et al., 2004), the associations between the three psychiatric disorders were roughly similar. In this population, 28.5% of the migraine subjects were considered clinically depressed, while only 12.3% of subjects without migraine fit the same criteria (OR 2.8). Comorbidity with psychological distress was related to a poorer health-related quality of life in patients with migraine (Wang et al., 2001). In a recent study, patients with disabling chronic headache had high frequencies of somatic complaints (OR 8.6) and major depressive disorder (OR 25.1) (Tietjen et al., 2007). We used a 30-item version of the Chinese Health Questionnaire (CHQ-30) to screen minor psychiatric morbidity if the score was > 10 in a Taiwan population. The study showed that subjects with chronic migraine had a higher chance to have a positive screening result in the CHQ-30 score (>10) than those with chronic tension-type headache (CTTH) (66% vs. 36%) (Lu et al., 2001). In clinic-based studies, patients with chronic daily headache, especially chronic migraine, had high frequencies of major depression and panic disorders (Juang et al., 2000). In addition, the presence of major depression was a poor outcome predictor in patients with chronic daily headache (RR = 1.8) (Lu et al., 2000).

Comorbidity with psychological distress was related to poorer  health outcomes and poorer health-related quality of life. Depression makes all pain harder to cope with and takes away the will to fight it as well.

When it comes to comorbids I have many. I have fibromyalgia, depression, suicidal thoughts and actions, allodynia (which can be extremely painful), asthma and I believe thought not in this article Hypothyroidism is a comorbid and I have that one as well. Under CVD is our white matter brain lesions, and I have those as well. That would be these:

Sub-clinical vascular brain lesions

Sub-clinical cerebral lesions, especially in the posterior circulation or white matter, were reported to be more frequent in patients with migraine (especially migraine with aura) in a case-controlled MRI study (CAMERA) (Kruit et al., 2004). The same group also demonstrated that most (88%) infratentorial infarct-like lesions had a vascular border zone location in the cerebellum and, further, that a combination of hypoperfusion (possibly migraine attack-related) and embolism is the most likely mechanism for posterior circulation infarction in migraine (Kruit et al., 2005). Recently, MRI was performed in participants of the AGES-Reykjavik Study, more than 26 years after the initial headache diagnosis. Women, but not men, with migraine with aura in midlife were associated with increased cerebellar infarct-like lesions in late life (Scher et al., 2009).

So there is a long list of comorbids under each group I listed on my graphic. And other miscellaneous ones like asthma and even narcolepsy. I have 7 of them so that should show how easily it is to get these comobids once you have one. Although FM came first for me. Nevertheless you end up with a cluster of conditions all working against each other than need to be treated. Like FM making the migraines worse, and migraines making the FM worse. And then the hypothyroid needing to be treated well but it mimics some symptoms of the FM so hard to know if you are getting the right amount of meds. Then asthma springs up from god knows where. So there is another med, which by the way may trigger a migraine when you take that.

The picture becomes complicated. The pain becomes very complicated.


Source: Comorbidities of Migraine


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