High Comorbidity Burden in Resistant, Refractory Migraine Vs Chronic Migraine
Treatment of comorbidities may help patients overcome resistance or refractoriness to migraine therapies.
People living with resistant or refractory migraine have a higher burden of comorbidity compared with patients with nonresistant or nonrefractory migraine, according to research results published in the Journal of Headache and Pain.1 These comorbidities may play a role in the progression of migraine from chronic to resistant or refractory disease.
Treatment of comorbidities may help patients overcome resistance or refractoriness to migraine therapies. | image credit: Damir Khabirov - stock.adobe.com
Little is known about the comorbidities associated with migraine that is resistant or refractory to certain preventive treatments. In the prospective, observational, multicenter, international REFINE study, investigators sought to explore the prevalence of 20 comorbidities in patients with nonresistant and nonrefractory migraine, resistant migraine, and refractory migraine.
The study cohort included 689 participants, of whom 82.8% were women (median age, 47 years; interquartile range [IQR], 38-56 years). A total of 10.4% of patients had refractory migraine, 38% had resistant migraine, and 51.4% had nonresistant and nonrefractory migraine. Patients with refractor or resistant migraine had a longer history of migraine compared with those with nonrefractory and nonresistant migraine (median, 34 vs 31 years). Chronic migraine and medication overuse history prevalence was significantly higher in patients with refractory or resistant migraine (83.6% vs 70.2% vs 40.1% and 45.2% vs 48.1% vs 19.8%) compared with the nonresistant and nonrefractive migraine group. Scores for the HIT-6, HADS-A, HADS-D, and ISI were also higher in these two groups.
Investigators found significant differences in multiple comorbidities, including depression, anxiety, sleep disturbance, trigger points, TMJ disorders, thyroiditis, cerebrovascular disease, and bipolar and other psychiatric disorders across the 3 patient groups. All comorbidities, excluding sleep disturbances, were more common in patients with refractory migraine.
Multiple comorbidities were also common in the refractory migraine group, with 80.6% of participants having 2 or more comorbidities, compared with 70.4% in the resistant migraine group and 56.8% in the nonrefractory and nonresistant migraine group; 69.4%, 49.4%, and 44.8% of participants in each group, respectively, had 3 or more comorbidities, while 55.6%, 35% and 31% in each group, respectively, had 4 or more comorbidities. However, “no clear pattern of association between comorbidities emerged across the 3 groups,” investigators noted.
READ MORE: Exploring Alternative Pain Management Strategies for Headaches and Migraine
Results of sensitivity analyses performed on 387 patients with chronic migraine showed a significant difference among the 3 groups for the presence of depression, anxiety, bipolar and other psychiatric disorders, cerebrovascular disease, trigger points, asthma, rhinitis, and thyroiditis. In each of these comorbidities, the refractory migraine group had the highest comorbidity prevalence.
Study limitations include potential differences in diagnosed comorbidities as diagnosed by each clinician, the multicenter nature of the study leading to variability in diagnostic criteria resulting in heterogeneity of data, and the reporting of only baseline cross-sectional data not designed to test causal relationships.
“Our data showed that [refractory migraine and resistant migraine] have a different prevalence of some comorbidities,” the researchers wrote. “Future research should focus on elucidating the underlying mechanisms that connect comorbidities with [refractory and resistant migraine]. Understanding these mechanisms could potentially guide the development of targeted therapeutic approaches—both pharmacological and nonpharmacological—that consider the high disease burden and complexity of managing multiple pharmacological treatments for both migraine and associated comorbidities.”
READ MORE: Pain Management Resource Center
