Migraine & Pain Comorbidity


Relationships between chronic pain conditions, including migraine, are complex, with multiple factors accounting for their co-occurrence, including occupation, injuries, and the presence of other comorbid disorders (eg, psychiatric diagnoses) and health risks (eg, obesity).[1] Several studies have documented the co-occurrence of migraine with other pain disorders in samples of children and adults.

Migraine and Comorbid Pain in Adults

The Nord-Trendelag Health Study, a cross-sectional population-based study in which over 50,000 individuals responded to questions concerning headache and musculoskeletal symptoms, found that migraine sufferers were almost two times more likely (OR: 1.9; 95% CI: 1.8 to 2.0) than individuals without migraine to report musculoskeletal symptoms.[2] The strongest predictor of comorbid musculoskeletal symptoms was headache frequency. Men with headaches on 7 to 14 days per month and ≥15 days per month, respectively, were 3.2 (95% CI: 2.8 to 3.8) and 3.6 (95% CI: 2.9 to 4.5) times more likely to have musculoskeletal complaints than those without headaches. Similarly, women with headaches on 7 to 14 days per month and ≥15 days per month, respectively, were 3.2 (95% CI: 2.9 to 3.5) and 5.3 (95% CI: 4.4 to 6.5) times more likely to have musculoskeletal complaints than those without headaches.

Von Korff and colleagues reported results from the National Comorbidity Survey Replication (NCS-R), a population-based household survey of adults ≥18 years of age (N=5,692) that examined associations between comorbid back and neck pain and other physical and mental disorders.[3] The prevalence of chronic spinal pain was over 3-fold higher in individuals with other chronic pain conditions, including migraine, compared to those without (34.1% versus 9.6%, respectively). The study demonstrated associations between chronic spinal pain and psychiatric conditions (anxiety, depression, and substance abuse), but the strongest associations were found between chronic spinal pain and other pain disorders (OR: 4.8 [95% CI: 3.9 to 5.8]): arthritis (OR: 3.9 [95% CI: 3.2 to 4.7]), migraine (OR: 5.2 [95% CI: 4.1 to 6.4]), other headache (OR: 4.0 [95% CI: 2.9 to 5.3]), and other chronic pain (OR: 3.7 [95% CI: 2.9 to 4.7]).

Migraine and Comorbid Pain in Children and Adolescents

Associations between other chronic pain conditions and migraine have been demonstrated in studies conducted in children or young adults. One cross-sectional survey evaluated musculoskeletal pain and factors predicting persistence and recurrence in 1,756 school children (third and fifth graders) in Finland.[4] Participants were evaluated at baseline by means of a structured questionnaire and physical examination and at 1- and 4-year follow-up, using the same structured questionnaire. In multivariate analysis, headache (frequency: ≥1 per week) at baseline, not characterized by type, predicted persistent musculoskeletal pain at follow-up (relative risk: 1.28 [95% CI: 1.08 to 1.51]).

Another study based on data from the Danish Twin Register examined associations between lower back pain and other health conditions in adolescents and young adults.[5] Hestbaek and colleagues found that a cluster of comorbid conditions, including headache (not characterized by type), asthma, and lower back pain at baseline predicted persistence of lower back pain at 8-year follow-up. Subjects with this cluster of conditions at baseline were 4.5 times more likely than those without these conditions to have persistent lower back pain at follow-up (OR: 4.5 [95% CI: 2.5 to 8.1]).

view references
1. Scher, A.I., W.F. Stewart, and R.B. Lipton, The comorbidity of headache with other pain syndromes. Headache, 2006. 46(9): p. 1416-1423. 2. Hagen, K., et al., The co-occurrence of headache and musculoskeletal symptoms amongst 51 050 adults in Norway. Eur J Neurol, 2002. 9(5): p. 527-533. 3. Von Korff, M., et al., Chronic spinal pain and physical—mental comorbidity in the United States: results from the national comorbidity survey replication. Pain, 2005. 113(3): p. 331-339. 4. El-Metwally, A., et al., Prognosis of non-specific musculoskeletal pain in preadolescents: A prospective 4-year follow-up study till adolescence. Pain, 2004. 110(3): p. 550-559. 5. Hestbaek, L., C. Leboeuf-Yde, and K.O. Kyvik, Is comorbidity in adolescence a predictor for adult low back pain? A prospective study of a young population. BMC Musculoskelet Disord, 2006. 7: p. 29.
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