Trial Report Fatigue, CFS and migraine: Intersecting the lines through a cross-sectional study in patients with episodic and chronic migraine, 2023, Kumar

[Dolphin]

Free:
https://ruralneuropractice.com/fati...-patients-with-episodic-and-chronic-migraine/

Fatigue, chronic fatigue syndrome and migraine: Intersecting the lines through a cross-sectional study in patients with episodic and chronic migraine

Hemant Kumar1, Kamakshi Dhamija2, Ashish Duggal1, Geeta Anjum Khwaja1, Sujata Roshan1

1Department of Neurology, GIPMER, Delhi, India
2Department of Neurology, VMMC and Safdarjung Hospital, Delhi, India
*Corresponding author: Sujata Roshan, Associate Professor Room no 501, Department of Neurology, GIPMER, Delhi, India. drsujataroshan@gmail.com

Received: 2022-12-05, Accepted: 2023-03-15, Epub ahead of print: 2023-04-20, Published: 2023-08-16

How to cite this article: Kumar H, Dhamija K, Duggal A, Khwaja GA, Roshan S. Fatigue, chronic fatigue syndrome and migraine: Intersecting the lines through a cross-sectional study in patients with episodic and chronic migraine. J Neurosci Rural Pract 2023;14:424-31.

ABSTRACT

OBJECTIVES:
Fatigue is a common symptom occurring in a variety of disorders. Chronic fatigue syndrome (CFS) is characterized by debilitating fatigue as the core symptom. The risk of CFS is nearly 1.5 times higher in migraine while headaches have been reported in 59% of cases with CFS. However, details of its occurrence and severity remain largely unexplored. The primary objective of our study was to determine the occurrence and severity of fatigue and CFS in patients with episodic and chronic migraine. The secondary objectives were to define their relationship with other common comorbidities.

MATERIALS AND METHODS:
60 migraine patients (30 each, episodic [EM] and chronic migraine [CM]) were recruited from Neurology Outpatient Department, GIPMER a tertiary referral center in New Delhi, India. Patients’ headache severity was analyzed using the Headache impact test-6 (HIT-6) score while fatigue and other migraine accompaniments were assessed using Fatigue severity scale (FSS), Chalder fatigue scale, CDC diagnostic criteria for CFS, American College of Rheumatology Diagnostic Criteria for fibromyalgia, Hamilton Depression Scale, the Generalized Anxiety Disorder 7-Item Scale, and Epworth sleepiness Scale (ESS). Comparative analysis was further done among migraine patients with and without fatigue and CFS.

RESULTS:
The mean HIT-6 score was significantly higher in CM versus EM. The CM group had a higher mean FSS score (47.87 vs. 37.3 in EM; P = 0.004), a percentage of patients with severe fatigue (60% vs. 20% in EM; P = 0.004), and a higher percentage of patients with pathological fatigue (83.3% vs. 63.3% in EM; P = 0.04). Around 23.33% of CM patients fulfilled the criteria of CFS. Fatigue correlated positively with severity, frequency, attack duration and chronicity of the migraine episodes, along with depression, anxiety, and excessive daytime sleepiness.

CONCLUSION:
Fatigue and related comorbid disorders are significantly more common in CM than in EM, expanding the morbidity of the condition and underscores the need to address these accompanying symptoms for devising a holistic treatment plan.

Keywords
Fatigue
Migraine
Anxiety
Depression
Chronic fatigue syndrome

 

[Trish]

Assessment of CFS in migraine
CDC diagnostic criteria for CFS or myalgic encephalomyelitis: [10] includes new-onset fatigue of at least 6 months duration, not relieved by rest, not due to organic causes, and associated with four out of seven symptoms (sore throat, tender axillary or cervical lymph nodes, impaired memory/concentration, muscle pain, pain in several joints, unrefreshing sleep, and new headache).

No mention anywhere I can see of PEM. I think if someone has frequent migraines they are likely to be fatigued, suffer brain fog at least during the migraines, unrefreshing sleep and obviously headache. Not difficult to see chronic migraines being misdiagnosed on this definition as CFS.

 

[Peter T]

Also it is a complex issue teasing apart migraines as a symptom of ME and migraines co occurring with ME. I get migraines when in PEM and I see them as a symptom of the PEM, their frequency, duration and severity are associated with the current severity of my overall ME. However I also get migraines as a symptom of my food intolerances, which happens independently of the current severity of my ME rather when I accidentally consume something I am intolerant of, for example when I forgot to check that some falafels from a German Turkish restaurant were made with only gram flour and did not have added wheat flour.

There does not seem to be any clear distinction between the features of the migraines occurring in these two different situations, however the former seems a clear cut symptom of ME.

Just as fatigue is a symptom of many different pathologies, can migraines also be a symptom of different pathologies as well as an independent condition?

Also when my ME is at its most severe I am in almost continuous PEM and so experience chronic migraine, but when my ME is less severe, PEM is episodic so the associated migraines are episodic too.

The migraines I get arising from food intolerances alternatively could be regarded as cooccurring with my ME but not directly arising directly from it, though this is confused as my food intolerances only developed after the onset of my ME and though an individual intolerance does not directly vary with my ME, over the years with the worsening of my ME additional intolerances to new foodstuffs have developed. Before I had identified my food intolerances I was continuously eating food stuffs that triggered migraines so was experiencing a number of migraines each week (would this be regarded as chronic?), but now I only rarely get food related migraines so these are unambiguously episodic.

 

[Ash]

Also it is a complex issue teasing apart migraines as a symptom of ME and migraines co occurring with ME. I get migraines when in PEM and I see them as a symptom of the PEM, their frequency, duration and severity are associated with the current severity of my overall ME. However I also get migraines as a symptom of my food intolerances, which happens independently of the current severity of my ME rather when I accidentally consume something I am intolerant of, for example when I forgot to check that some falafels from a German Turkish restaurant were made with only gram flour and did not have added wheat flour.

There does not seem to be any clear distinction between the features of the migraines occurring in these two different situations, however the former seems a clear cut symptom of ME.

Just as fatigue is a symptom of many different pathologies, can migraines also be a symptom of different pathologies as well as an independent condition?

Also when my ME is at its most severe I am in almost continuous PEM and so experience chronic migraine, but when my ME is less severe, PEM is episodic so the associated migraines are episodic too.

The migraines I get arising from food intolerances alternatively could be regarded as cooccurring with my ME but not directly arising directly from it, though this is confused as my food intolerances only developed after the onset of my ME and though an individual intolerance does not directly vary with my ME, over the years with the worsening of my ME additional intolerances to new foodstuffs have developed. Before I had identified my food intolerances I was continuously eating food stuffs that triggered migraines so was experiencing a number of migraines each week (would this be regarded as chronic?), but now I only rarely get food related migraines so these are unambiguously episodic.

I have this exact experience!!!
You described that relationship so well.
It’s not pleasant is it….

 

[Joan Crawford]

There are now science based monoclonal antibody treatments for migraine.

https://migrainetrust.org/live-with...n-gene-related-peptide-monoclonal-antibodies/

They specifically block the process that results in migraine symptoms.

I'm aware of several pwME who also have migraines who have benefited from these new treatments. Not helped their ME symptoms much.

I am.in month 4 and the change in my functioning is a revelation. My neurologist is pleased. As am I yay.

ME and migraine are overlapping conditions but I suspect different underlying processes.

As an aside, the scientific development process to understand migraine and develop effective science based treatments is sorely needed for ME.

 

[Ash]

There are now science based monoclonal antibody treatments for migraine.

https://migrainetrust.org/live-with...n-gene-related-peptide-monoclonal-antibodies/

They specifically block the process that results in migraine symptoms.

I'm aware of several pwME who also have migraines who have benefited from these new treatments. Not helped their ME symptoms much.

I am.in month 4 and the change in my functioning is a revelation. My neurologist is pleased. As am I yay.

ME and migraine are overlapping conditions but I suspect different underlying processes.

As an aside, the scientific development process to understand migraine and develop effective science based treatments is sorely needed for ME.

Oh wow I am happy for you!!!
Would I need to be under a neurologist to access this because I don’t see this being possible with out acquiring the unwelcome passenger of FND….?

 

[bobbler]

Also it is a complex issue teasing apart migraines as a symptom of ME and migraines co occurring with ME. I get migraines when in PEM and I see them as a symptom of the PEM, their frequency, duration and severity are associated with the current severity of my overall ME. However I also get migraines as a symptom of my food intolerances, which happens independently of the current severity of my ME rather when I accidentally consume something I am intolerant of, for example when I forgot to check that some falafels from a German Turkish restaurant were made with only gram flour and did not have added wheat flour.

There does not seem to be any clear distinction between the features of the migraines occurring in these two different situations, however the former seems a clear cut symptom of ME.

Just as fatigue is a symptom of many different pathologies, can migraines also be a symptom of different pathologies as well as an independent condition?

Also when my ME is at its most severe I am in almost continuous PEM and so experience chronic migraine, but when my ME is less severe, PEM is episodic so the associated migraines are episodic too.

The migraines I get arising from food intolerances alternatively could be regarded as cooccurring with my ME but not directly arising directly from it, though this is confused as my food intolerances only developed after the onset of my ME and though an individual intolerance does not directly vary with my ME, over the years with the worsening of my ME additional intolerances to new foodstuffs have developed. Before I had identified my food intolerances I was continuously eating food stuffs that triggered migraines so was experiencing a number of migraines each week (would this be regarded as chronic?), but now I only rarely get food related migraines so these are unambiguously episodic.

I would agree in most of this having been similar for me. I can't believe that I just had to remind myself that it is B12 injections for me that made the difference because for a moment I used to remember being at work and so many FRidays having to race home with migraine whilst I could still get home. SO it was very much about exhaustion, pushing thorugh, but I think also light (there are indeed certain foodstuffs too). Then I remembered that as I got more severe adn was no longer at work I couldn't watch TV for even 10mins without getting migraines, so it was constant. It has been long enough now of the B12 injections that I forgot how constant and debilitating a state that was before them, and just remembered back to the work episodes. Although I am careful now about not watching tv in low light even and anything that flashes like fairy lights are terrible and can more easily avoid the terrible lights that outside the home e.g. bright sun in eyes or overhead lighting etc would occur that was a huge step forward, and have to be careful about not overdoing it with e.g. screens or watching anyhing hectic particularly when not on a very good day etc.

I'd feel more confident this was being done in good faith if I felt 'holistic' and the chosen comorbidities weren't seen by the authors as psych-based to send off to psych. Which is a real shame because if they drilled-down into the specifics of how these overlaps differ in specifics across persons then maybe there would be clues as to what could be on a list of things to help people who have different presentations/types.

 

[Ash]

I'd feel more confident this was being done in good faith if I felt 'holistic' and the chosen comorbidities weren't seen by the authors as psych-based to send off to psych. Which is a real shame because if they drilled-down into the specifics of how these overlaps differ in specifics across persons then maybe there would be clues as to what could be on a list of things to help people who have different presentations/types.

Yes I am not at all confident that they’re going to help us out on this one.

Me too!
The flashing lights and overhead lighting, terrible. Unfortunately also day light 9am -6pm on a really glare-ish day, worse when there are clouds and bright white light, rather than pure sunshine. On days with warmer spectrum and softer light it’s only 11.30 am-3.30pm that I have to exist in a vampire layer.

 

[Joan Crawford]

Oh wow I am happy for you!!!
Would I need to be under a neurologist to access this because I don’t see this being possible with out acquiring the unwelcome passenger of FND….?

Tbh, I doubt neurologists who entertain FND are of the same variety who understand these new migraine treatments and the science behind them. I wonder why migraine never seems to show itself with FND. I suspect, being cynical, that too many neurologists get migraines for that to wash. Weird, eh?

If u r in the UK, and you would meet criteria, ask your GP for referral to either The Walton Centre in Liverpool or your local major neurological centre, like Manchester, Birmingham or London. Or ask your neurologist for this or into headache clinic. Good luck x

 

[Ash]

Tbh, I doubt neurologists who entertain FND are of the same variety who understand these new migraine treatments and the science behind them. I wonder why migraine never seems to show itself with FND. I suspect, being cynical, that too many neurologists get migraines for that to wash. Weird, eh?

If u r in the UK, and you would meet criteria, ask your GP for referral to either The Walton Centre in Liverpool or your local major neurological centre, like Manchester, Birmingham or London. Or ask your neurologist for this or into headache clinic. Good luck x

Good point. I think they absolutely do try to FND migraines, but usually it’s far down the list and I bet you’re right about why that is!

Ill look into it as soon as I have a little mental energy, see if I can sell it to my GPs although I may have to leave them soon due to their attitudes ME and my care specifically.

Thanks for this super useful advice!

I needed to hear a good news story

 

[Joan Crawford]

Good point. I think they absolutely do try to FND migraines, but usually it’s far down the list and I bet you’re right about why that is!

Ill look into it as soon as I have a little mental energy, see if I can sell it to my GPs although I may have to leave them soon due to their attitudes ME and my care specifically.

Thanks for this super useful advice!

I needed to hear a good news story

And GPs are often a lot more helpful with migraine as they can 'do' something useful. And most GP practices have patients on these new treatments doing well so it will probably not be news to them. You do need a history of having 'tried' I.e. been prescribed 3 things that didn't help much that are prescribed for migraine like gabapentin, pregabalin, amitriptiline, propranolol, Sumatriptan etc, etc. There are lots of meds available to try in migraine so have a think and discuss with your GP.

I hope it goes well for you.

X

 

[Ash]

And GPs are often a lot more helpful with migraine as they can 'do' something useful. And most GP practices have patients on these new treatments doing well so it will probably not be news to them. You do need a history of having 'tried' I.e. been prescribed 3 things that didn't help much that are prescribed for migraine like gabapentin, pregabalin, amitriptiline, propranolol, Sumatriptan etc, etc. There are lots of meds available to try in migraine so have a think and discuss with your GP.

I hope it goes well for you.

X

Thanks @Joan Crawford!
I’ve had most of those already and been told I cannot have one. So maybe….