Fibromyalgia Worsens Depression, Pain Intensity in Migraine

Both fibromyalgia and migraine are debilitating pain disorders that have far-reaching impacts on quality of life and can add to the morbidity of the other disorder if both present. Building on prior research drawing a link between migraine and fibromyalgia comorbidity, a new study has found that fibromyalgia exacerbates depressive symptoms, migraine intensity, and migraine-related disability.

The study of 157 patients with comorbid migraine and fibromyalgia and 471 controls with just migraine assessed the difference in pain and depressive symptoms between the 2 cohorts from 2012 to 2017. Participants’ body mass index, number of headache days per month prior to the initial visit, age of onset of headache, number of subjects with 15 or more headache days within the past month, and average duration of migraine were all recorded.

The researchers observed no significant differences in these characteristics between the 2 cohorts. They did note that the majority of the participants had chronic migraine, which is associated with medication overuse and medication overuse was not accounted for in the study.

To read more on migraine comorbidities, click here.

To screen for depression, researchers used the Patient Health Questionnaire, known as PHQ-9, which included 9 statements of depressive symptoms rated from 0 to 3 over the previous 2 weeks. Those with comorbid migraine and fibromyalgia had higher scores—indicating more days with depressive symptoms—and were more likely to score in a higher migraine severity category on the questionnaire.

These participants were also more likely to report higher intensity of migraine (odds ratio [OR], 1.15; 95% CI 1.04-1.27; P = .0065).

A participant’s migraine-related disability was measured by the MIDAS scale, which inquired about days a participant missed or had reduced productivity in school and work, household work, and social, leisure, and family activities.

While there was no significant difference in the total MIDAS score, participants with comorbid migraine and fibromyalgia were more likely to have a higher grade of migraine-related disability.

“The presence of fibromyalgia has been correlated with lower quality of life in patients with migraine, making it important to know when to screen for symptoms of fibromyalgia in the migraine population,” wrote the researchers. “Our findings suggest that it is important to inquire about comorbid fibromyalgia as this needs to be taken into consideration with regards to creating an optimal individualized treatment plan.”

They added that, based on the study, it would be reasonable to screen for fibromyalgia symptoms when a patient with migraine reports a number of depressive symptoms, severe migraine intensity, or severe migraine-related disability.

With pain symptoms and depression often being linked and previous studies suggesting shared genetic mechanisms between major depressive disorder and migraine, some researchers have posed the idea of integrating migraine and depression treatment in order to improve patients' pain symptoms and health-related quality of life.

Reference:

Whealy M, Nanda S, Vincent A, et al. Fibromyalgia in migraine: a retrospective cohort study [published online July 31, 2018]. J Headache Pain. doi: https://doi.org/10.1186/s10194-018-0892-9.