Migraine headaches in Chronic Fatigue Syndrome (CFS): Comparison of two prospective cross-sectional studies

Abstract

BackgroundHeadaches 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.MethodsSubjects 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).ResultsDemographics, 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.ConclusionsCFS 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 RegistrationGeorgetown University IRB # 2006-481ClinicalTrials.gov NCT00810329

Comorbidity in Migraine with Functional Somatic Syndromes, Psychiatric Disorders and Inflammatory Diseases: A Matter of Central Sensitization?

“…The association between migraine and FSSs is supported by earlier studies. [7][8][9]11,12 The current results do also confirm prior findings of an association between migraine and airway disease. 35,36 To our knowledge, neither relatively high prevalence of diagnosed exhaustion syndrome nor elevated level of burnout have previously been reported for migraine.…”

“…Thus, there is support for migraine being associated with functional somatic syndromes (FSSs; physical illnesses without an organic disease explanation and devoid of demonstrable structural lesion or established biochemical change 6 ), including fibromyalgia, 7-10 irritable bowel syndrome (IBS), 11 and chronic fatigue syndrome (CFS). 12 It has been questioned as to whether migraine should be considered a FSS. 13 According to Warren and Clauw, 14 the more interesting question may not be whether migraine is a FSS, but rather why migraine appears to be associated with these syndromes.…”

Central sensitization as a component of post-deployment syndrome

“…The similarity between PDS and other medically unexplained conditions such as fibromyalgia [26,76], chronic fatigue syndrome [3,33,37], irritable bowel syndrome [74], post-concussion disorder [4,36], chronic headache [57], and post-traumatic stress disorder [43] has been previously noted [34]. In all these conditions, CWP occurs together with memory difficulties, fatigue, sleep disturbances and, often, depressed mood [75].…”

Migraine: risk factor and comorbidity

“…Fibromyalgia is very common in migraineurs with a prevalence that ranges from 16.8 to 35.6 % and, vice versa, migraine prevalence ranges from 45 to 48 % in fibromyalgia sufferers [25]. Some studies reported a bidirectional association between chronic migraine and chronic fatigue syndrome [2,26].…”