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. 2017 Aug 1;89(5):461-468.
doi: 10.1212/WNL.0000000000004177. Epub 2017 Jul 5.

Comorbid pain and migraine chronicity: The Chronic Migraine Epidemiology and Outcomes Study

Ann I Scher  1 , Dawn C Buse  1 , Kristina M Fanning  1 , Amanda M Kelly  1 , Dana A Franznick  1 , Aubrey M Adams  1 , Richard B Lipton  2
Affiliations

Comorbid pain and migraine chronicity: The Chronic Migraine Epidemiology and Outcomes Study

Ann I Scher et al. Neurology. .

Abstract

Objective: To identify patterns of noncephalic pain comorbidity in people with episodic migraine (EM; <15 headache-days per month) and chronic migraine (CM; ≥15 headache-days per month) and to examine whether the presence of noncephalic pain is an indicator for the 3-month onset or persistence of CM.

Methods: Data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a prospective, web-based study with cross-sectional modules embedded in a longitudinal design, were analyzed at baseline and the 3-month follow-up. Relationships between the number of noncephalic pain sites and 3-month onset of CM or persistent CM were assessed.

Results: Of 8,908 eligible respondents, 8,139 (91.4%) had EM and 769 (8.6%) had CM at baseline. At 3 months, the incidence of CM among those with baseline EM was 3.4%. When adjusted for demographics and headache-day frequency, the odds of CM onset among those with baseline EM increased by 30% (95% confidence interval [CI] 1.21-1.40, p < 0.001) for each additional noncephalic pain site at baseline. Among those with CM at baseline, 50.1% had persistent CM at the 3-month follow-up. After adjustment for demographics, individuals with CM were 15% (95% CI 1.07-1.25, p < 0.001) more likely to have persistent CM for each additional noncephalic pain site at baseline.

Conclusions: These results suggest that noncephalic pain may be a marker for headache chronicity that could be used to identify people with EM at risk of the onset of CM and people with CM at risk of persistent CM.

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Figures

Figure 1
Figure 1. Headache-day frequency by noncephalic pain region
The frequency of headache days by (A) presence of pain most/all of the time or (B) severe pain intensity. Pain frequency at each location was assessed with the Total Pain Index. Response options included none of the time, a slight bit of time, some of the time, most of the time, and all of the time. Pain severity was assessed by the Total Pain Index. Respondents were asked to rate pain severity on a scale from 0 (no pain) to 10 (worst pain you have had), and severe pain intensity was defined as a score ≥8. *p < 0.05; p < 0.001 for all other comparisons.
Figure 2
Figure 2. Transition in headache-day status
Transition in headache-day status from baseline to 3-month follow-up. CM = chronic migraine (≥15 headache-days per month); EM = episodic migraine (<15 headache-days per month).
See this image and copyright information in PMC

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