Major Finding: Adults with migraines and a history of head or neck injury had more frequent headaches than did migraineurs without injuries (16 vs. 13 days/month, respectively) as well as disabling headaches (mean score on the Headache Impact Test-6, 60 vs. 54, respectively) and higher rates of various comorbidities.
Data Source: Self-administered electronic questionnaires completed by 1,348 clinic patients.
Disclosures: Dr. Tietjen has received research grants from GlaxoSmithKline and consulting fees and honoraria from MAP Pharmaceuticals. A grant from the American Headache Society's Women's Issues Section funded the study.
LOS ANGELES – Migraine patients with a history of head or neck injury reported more frequent and disabling headaches and higher rates of a variety of comorbidities than did migraineurs without head or neck injuries in a survey of 1,348 adult patients.
Some migraine features differed significantly between patients with or without a history of head or neck injury, according to responses to electronic questionnaires that were completed by patients seen in clinics for their migraine headaches, Dr. Gretchen E. Tietjen reported.
In the survey, Dr. Tietjen and her associates gathered information from 373 patients with a history of head or neck injury. The patients with head or neck injury averaged 16 days with headaches per month, compared with 13 days per month in 975 noninjured patients.
Chronic headaches (defined as headaches on more than 15 days/month) were a problem for 42% of patients with a history of injury and 31% of those who had not been injured.
Scores on the Headache Impact Test–6 averaged 60 in the injured group and 54 in the noninjured group. This difference suggested a greater impact of headaches on daily life in the injured group.
“One thing I wasn't expecting” was a consistent difference between groups in prevalence rates of comorbidities, said Dr. Tietjen, who serves as professor and chair of the neurology department at the University of Toledo (Ohio).
Comparing the injured group with the noninjured group, prevalence rates were 52% vs. 35% for depression, 40% vs. 27% for anxiety, 37% vs. 21% for arthritis, and 30% vs. 21% for irritable bowel syndrome.
Other differences in prevalence rates were 16% vs. 7% for fibromyalgia, 11% vs. 6% for sleep apnea, 9% vs. 5% for interstitial cystitis, and 17% vs. 10% for uterine fibroids, respectively.
Each of these differences between groups was statistically significant.
Patients developed symptoms of these comorbidities and were diagnosed at an earlier age if they had a history of injury than if they had not been injured. The onset of depression, anxiety, sleep apnea, and fibromyalgia occurred at a significantly earlier age in those who had been injured than in those who had not, she said.
Patients who had a history of injury were significantly more likely to have a history of substance abuse (24%), compared with noninjured patients (16%), and to have an education level no higher than high school (32% vs. 25%, respectively).
Among patients with a history of head or neck injury in whom the timing of the injury was known, the 45 patients whose migraines started concurrently with the injury were less likely to have migraine with aura, compared with the 170 patients whose migraines started prior to the injury or the 109 patients whose migraines began after the injury.
The migraines came with aura in 22% of the subgroup with concurrent-onset migraine, 45% of the subgroup with migraine before their injury, and 47% of those with migraine after their injury.
Patients in the concurrent-onset group also were statistically significantly younger (average age, 40 years), compared with the patients whose migraines started before the injury (42 years) or patients whose migraines started after injury (44 years).
The questionnaire did not ask about the nature or causes of the head and neck injuries.
Patients were asked about the number of head and neck injuries, their age at the first one, their age at the worst injury, whether or not there was a loss of consciousness associated with the injury, and when they were diagnosed with migraine headache.
A physician in the audience asked Dr. Tietjen whether the head injuries might have contributed to the development of psychosomatic syndromes that increased the prevalence of comorbidities.
Dr. Tietjen doubted that this was the case, given the wide nature of the comorbidities that included conditions such as uterine fibroids.
“I think it might be more mental/physiologic than just psychological,” she said.