Endometriosis Associated With Prevalence of Comorbid Conditions in Migraine
Endometriosis Associated With Prevalence of Comorbid Conditions in Migraine
Objective: To examine the headache characteristics of women with migraine and endometriosis (EM), and differences in the prevalence of comorbid conditions between female migraineurs with EM, without EM and nonheadache controls.
Background: Migraine and EM are common conditions in women of reproductive age, and both are influenced by ovarian hormones. The comorbidity of migraine and EM is newly recognized, but reasons for the association are uncertain.
Methods: This is a cross-sectional study of female headache outpatients and healthy controls conducted at University of Toledo and Duke University in 2005 and 2006. After a headache specialist determined headache frequency and diagnosis (based on criteria of the second International Classification of Headache Disorders), patients completed a self-administered electronic survey with information on demographics, headache-related disability, menstrual disorders, premenstrual dysphoric disorder (PMDD), vascular event risk, and comorbid conditions, including irritable bowel syndrome (IBS), fibromyalgia (FM), chronic fatigue syndrome (CFS), interstitial cystitis (IC), depression, and anxiety.
Results: Study enrolled 171 women with migraine and 104 controls. EM was reported more commonly in migraineurs than in controls (22% vs 9.6%, P < .01). Frequency of chronic headache was higher in migraineurs with EM compared to without EM (P = .002) and median headache-related disability scores were also higher in the EM group (P = .025). Symptoms of PMDD were more common in migraineurs, but frequency did not differ by EM status. Migraineurs with EM reported more menorrhagia, dysmenorrhea, and infertility compared to the migraine cohort without EM and to controls. Depression, anxiety, IBS, FM, CFS, and IC were more common in migraine with EM group than in controls. Anxiety (OR = 2.2, 95% CI 1.0-4.7), IC (OR = 10.6, 95% CI 1.9-56.5), and CFS (OR = 3.6, 95% CI 1.1-11.5) were more common in migraine with EM group, than in the cohort with migraine without EM.
Conclusion: Prevalence of EM is higher in women with migraine than in nonheadache controls. Migraineurs with EM have more frequent and disabling headaches, and are more likely to have other comorbid conditions affecting mood and pain, compared to migraineurs without EM.
Among women of reproductive age, migraine and endometriosis (EM), hormonally influenced conditions with a wide spectrum of severity, are highly prevalent. The prevalence of migraine in women ranges between 15% and 18%. Endometriosis, a condition characterized by endometrial tissue growing outside the uterus, occurs in 5.5 million women in the United States alone, and is estimated to occur in 10% of women of reproductive age. Like migraine, EM has been demonstrated to have a greater than coincidental association with asthma, hypothyroidism, chronic fatigue syndrome, and fibromyalgia. Studies have suggested that migraine and EM are themselves comorbid, but there has been little research into characteristics of this overlap population. Although the nature of the linkage remains speculative, it has been suggested that the sensory fibers from ectopic endometrial implants produce central sensitization responsible for widespread hyperexcitability of neurons in the central nervous system.
Our objectives in this study are to examine (1) the headache characteristics of women with migraine and EM compared to female migraineurs without EM and (2) the association of EM with other comorbid conditions in women with migraine, and in nonheadache controls.
Abstract and Introduction
Abstract
Objective: To examine the headache characteristics of women with migraine and endometriosis (EM), and differences in the prevalence of comorbid conditions between female migraineurs with EM, without EM and nonheadache controls.
Background: Migraine and EM are common conditions in women of reproductive age, and both are influenced by ovarian hormones. The comorbidity of migraine and EM is newly recognized, but reasons for the association are uncertain.
Methods: This is a cross-sectional study of female headache outpatients and healthy controls conducted at University of Toledo and Duke University in 2005 and 2006. After a headache specialist determined headache frequency and diagnosis (based on criteria of the second International Classification of Headache Disorders), patients completed a self-administered electronic survey with information on demographics, headache-related disability, menstrual disorders, premenstrual dysphoric disorder (PMDD), vascular event risk, and comorbid conditions, including irritable bowel syndrome (IBS), fibromyalgia (FM), chronic fatigue syndrome (CFS), interstitial cystitis (IC), depression, and anxiety.
Results: Study enrolled 171 women with migraine and 104 controls. EM was reported more commonly in migraineurs than in controls (22% vs 9.6%, P < .01). Frequency of chronic headache was higher in migraineurs with EM compared to without EM (P = .002) and median headache-related disability scores were also higher in the EM group (P = .025). Symptoms of PMDD were more common in migraineurs, but frequency did not differ by EM status. Migraineurs with EM reported more menorrhagia, dysmenorrhea, and infertility compared to the migraine cohort without EM and to controls. Depression, anxiety, IBS, FM, CFS, and IC were more common in migraine with EM group than in controls. Anxiety (OR = 2.2, 95% CI 1.0-4.7), IC (OR = 10.6, 95% CI 1.9-56.5), and CFS (OR = 3.6, 95% CI 1.1-11.5) were more common in migraine with EM group, than in the cohort with migraine without EM.
Conclusion: Prevalence of EM is higher in women with migraine than in nonheadache controls. Migraineurs with EM have more frequent and disabling headaches, and are more likely to have other comorbid conditions affecting mood and pain, compared to migraineurs without EM.
Introduction
Among women of reproductive age, migraine and endometriosis (EM), hormonally influenced conditions with a wide spectrum of severity, are highly prevalent. The prevalence of migraine in women ranges between 15% and 18%. Endometriosis, a condition characterized by endometrial tissue growing outside the uterus, occurs in 5.5 million women in the United States alone, and is estimated to occur in 10% of women of reproductive age. Like migraine, EM has been demonstrated to have a greater than coincidental association with asthma, hypothyroidism, chronic fatigue syndrome, and fibromyalgia. Studies have suggested that migraine and EM are themselves comorbid, but there has been little research into characteristics of this overlap population. Although the nature of the linkage remains speculative, it has been suggested that the sensory fibers from ectopic endometrial implants produce central sensitization responsible for widespread hyperexcitability of neurons in the central nervous system.
Our objectives in this study are to examine (1) the headache characteristics of women with migraine and EM compared to female migraineurs without EM and (2) the association of EM with other comorbid conditions in women with migraine, and in nonheadache controls.