Cluster Headache Often Comorbid with Fibromyalgia, Migraine

A recent study indicated that the comorbidity of cluster headache with fibromyalgia and migraine appeared to be frequent.¹

“The comorbidity with fibromyalgia was especially associated with an increased disease burden in terms of additional medical comorbidities, sleep disturbance, mood impairment, quality of life impairment, and heavy HCRU,” wrote investigators, led by Elena P. Calandre, from the Institute of Neurosciences at University of Granada in Spain.

Comorbid diseases can increase a patient’s physical and psychological burden. While migraine is a known comorbidity of cluster headache, the prevalence of the 2 co-existing ranges from approximately 10% to 16.7%, studies have yet to identify other comorbidities.² Migraine is a well-investigated comorbidity of fibromyalgia, so investigators theorized cluster headache may also be a frequent comorbidity of fibromyalgia.¹

Investigators sought to describe the comorbidity and impact of fibromyalgia or migraine on patients with cluster headache by conducting an observational, cross-sectional study between 2020 and 2021. They uploaded a survey to the website, “Asociación de cefalea en racimos y primarias de España,” which translates to the Spanish association of cluster headache and other primary headaches. The association has members from Spain and Spanish-speaking American countries.

The survey collected sociodemographic and clinical data, including age, sex, marital status, educational status, and questions related to physician-diagnosed comorbid diseases. Participants aged ≥ 18 years completed questionnaires that measured depression, sleep quality, health-related quality of life, and healthcare resource utilization over the previous 6 months.

Among the 91 respondents with cluster headache, 42.9% (n = 39; 61.5% males) only experienced cluster headache, 16.5% (n = 15; 73.3% females) experienced cluster headache and migraine, 11% (n = 10; 100% females) experienced cluster headache and fibromyalgia, and 29.7% (n = 27; 85.2% females) experienced cluster headache with comorbid fibromyalgia and migraine.

Participants who experienced comorbid cluster headache and fibromyalgia were predominantly female, had a greater number of comorbid medical conditions, and had the greatest depression and sleep disturbance scores and the lowest health-related quality of life scores.

Moreover, respondents across the subgroups had moderate depression scores and positive suicidal ideation. Sleep quality and health-related quality of life were consistently poor across the subgroups, with significantly lower scores among participants diagnosed with cluster headache and comorbid migraine and fibromyalgia. Patients with cluster headache and comorbid migraine and fibromyalgia were the subgroup to have the lowest percentage of university education (P < .0001).

Osteoarticular conditions, particularly osteoarthritis, were the most frequently associated medical disease in patients with comorbid cluster headache, fibromyalgia, and with or without comorbid migraine. Other comorbidities reported included anxiety, depression, gastrointestinal and cardiovascular disorders, chronic fatigue syndrome, multiple chemical sensitivity, and food intolerance. Every subgroup had suicidal ideation, with 41% in patients with cluster headache, 33% with cluster headache and migraine, 90% with cluster headache and fibromyalgia, and 37% with cluster headache, migraine, and fibromyalgia.

The comorbidity of cluster headache with fibromyalgia and/or migraine appeared to be frequent. Like all comorbidities, this comorbidity increases patients’ psychosocial burden and reduces overall quality of life.

Investigators concluded by emphasizing the need for further studies to investigate the frequency and clinical relevance of cluster headache and comorbid fibromyalgia.

“We suggest that the risk of suicide in these populations should be further evaluated using a population-based study that increases representativeness, allows a better categorization of diagnoses, and includes a harder outcome measure such suicidal attempts and/or mortality due to suicide,” investigators wrote. “The potentially high rate of suicidal ideation in these patients suggests that careful screening and monitoring of the risk of suicide are of particular importance in clinical practice.”

References

1. ^{Calandre EP, Ordoñez-Carrasco JL, Slim M, Rico-Villademoros F, Garcia-Leiva JM. Comorbidity of migraine and fibromyalgia in patients with cluster headache: psychological burden and healthcare resource utilization. A cross-sectional study. J Oral Facial Pain Headache. 2024 Mar;38(1):32-39. doi: 10.22514/jofph.2024.004. Epub 2024 Mar 12. PMID: 39788574.}
2. ^{Song T, Lee MJ, Choi Y, Kim B, Chung P, Park J, et al. Differences in characteristics and comorbidity of cluster headache according to the presence of migraine. Journal of Clinical Neurology. 2019; 15: 334–338.}