Study Details Prevalence of Concurrent Migraine, Rheumatic Diseases

Patients with rheumatic disease have a 2-fold increase in migraine prevalence and a 3-fold increase in neuropathic pain prevalence compared with the general population, according to a study published in the Journal of Clinical Medicine.

Chronic inflammatory rheumatoid diseases (CIRDs) include rheumatic diseases such as rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA), all of which cause inflammatory pain and result in functional disability.

“The physiopathology of pain in rheumatic diseases remains unknown,” researchers explained. “Although many studies have described a link between chronic inflammatory activity and the risk of migraine in multiple sclerosis and inflammatory bowel disease, very few studies have described the occurrence of migraine in CIRDs.”

Study participants with RA (n = 238), SpA (n = 188), or PsA (n = 72) were recruited from the Department of Clermont-Ferrand University Hospital in France. One patient did not specify their rheumatic disease but was included in the study. In France, migraine is estimated to affect 21.3% of the population whereas the prevalence of chronic neuropathic pain is around 6.9%.

Clinical and demographic data, along with age, gender, tobacco use, type of rheumatic disease, and year of diagnosis, were collected by researchers. Participants also filled out questionnaires regarding migraine and neuropathic pain. Disease activity, functional disability, anxiety, and depression were also assessed via questionnaire.

Of the 499 participants, nearly two-thirds reported they experienced pain, while active disease was prevalent in the PsA cohort (47%). Migraine incidence was based on International Headache Society diagnostic criteria, and patients were diagnosed with neuropathic pain if they scored at least a 3 on the neuropathic pain diagnostic questionnaire.

Data revealed:

• In all study participants, migraine prevalence was 34% and was the highest in individuals with PsA.
• Risk factors for migraine included high level of anxiety, female sex, young age, and tumor necrosis factor (TNF)—alpha inhibitor treatment (odds ratio [OR], 1.90; 90% CI, 1.13-3.25).
• High disease activity was a risk factor for migraine in individuals with SpA.
• The entire population showed low systemic inflammation (median [interquartile range] blood CRP level, 3.0 [1.3-6.0] mg/L) and low rates of fibromyalgia (6%) and depression (8%).
• Overall prevalence of chronic migraine was very high (12%).
• Prevalence of neuropathic pain was highest in patients with SpA.
• Neuropathic pain was associated with migraine (P < .001).

“Compared to the general population, our cohort showed significantly higher rates of migraine (OR, 1.91; 95% CI, 1.57-2.32) and neuropathic pain (OR, 3.71; 95% CI, 2.97-4.62),” the authors wrote.

Investigators pointed out that neuropathic pain has been associated with a more severe disease course in RA and, “as risk factors (age, sex, anxiety, anti-TNF treatments) do not similarly affect migraine and neuropathic pain, this suggests that these two pain syndromes do not rely on the same mechanisms.”

The patient sample was not highly representable of the wider population of patients with rheumatic disease, as the disease was well controlled in most study participants. For this reason, authors caution that the findings may not be generalizable.

However, the findings “should raise the awareness of the value of examining patients with CIRDs accompanied by residual pain for the presence of migraine or neuropathic pain, despite adequate clinical control of the rheumatic disease,” the researchers concluded.

Reference:

Mathieu S, Couderc M, Pereira B, et al. Prevalence of migraine and neuropathic pain in rheumatic diseases. J Clin Med. 2020;9(6):1890. doi:10.3390/jcm9061890