Headache, Migraine Burden Significant in Psoriatic Arthritis, Axial Spondyloarthritis

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A new study investigating the prevalence of headache and migraine demonstrated an increased risk among patients with psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA).¹

Among the cohort in a single Italian rheumatologic center, patients with headache did not exhibit higher levels of measurable pain. Still, headache incidence correlated with increased rates of tender and swollen joints and higher scores in inflammation and functional status indexes.

“This result suggests a link between the systemic inflammation of spondyloarthritis and the immunological and pain-related patterns underlying the development of headache and migraine,” wrote the investigative team, led by Annalisa Marino, rheumatology and clinical immunology, department of medicine, University of Rome.

PsA and AxSpA are common inflammatory joint diseases, characterized by shared genetic backgrounds and similar clinical manifestations and comorbidities.² Each can affect a patient’s quality of life and significantly impair their physical, psychological, and social functioning.

Estimates from the World Health Organization (WHO) suggest more than 50% of adults are affected by headache worldwide—headaches are classified into 3 primary categories: migraine, tension-type, and cluster headaches.³ The most prevalent headache, migraine impacts ≥12% of the globe, and is characterized by recurrent, disabling attacks.

Prior research has suggested a connection between autoimmune diseases and migraine risk, but the link has not been confirmed. In this study, Marino and colleagues assessed the prevalence of headache and migraine, with and without aura, in a cohort with PsA and axSpA in a single center.¹ A total of 216 patients with PsA and 70 patients with axSpA, alongside 87 consecutive healthy controls, were enrolled in the study between July and November 2022.

For the analysis, clinical assessments included the number of tender joints (68 assessed joints), swollen joints (66 assessed joints), enthesitis, and dactylitis. Enthesitis assessment was made using the Leeds Enthesitis Index (LEI) and dactylitis was assessed as present or absent. Diagnoses of headache and migraine were determined using the interactional classification of headache disorders after the completion of a semi-structured diagnostic interview.

Participants in both cohorts were demographically comparable and did not differ at baseline from the healthy controls concerning gender, Charlson comorbidity index, or body mass index (BMI) prevalence. Among 216 participants with PsA, the prevalence of headache was 39.81%, noted as significantly higher than the 26.44% in the healthy controls (P = .028)

Moreover, the prevalence of migraine without aura was 18.52% in the patients with PsA, compared to 9.2% in the healthy controls (P = .044). The prevalence of aura did not significantly differ between those with PsA and the healthy control cohort.

Among those with axSpA, the prevalence of headache was 45.71% and the prevalence of migraine without aura was 28.57%. These were both significantly higher than the respective prevalence in healthy controls (P <.05). The prevalence of aura was not significantly different between patients with axSpA and the healthy controls.

After combining the two patient populations, the prevalence of headache (41.26%) and the prevalence of migraine without aura (20.98%) were significantly higher than the healthy controls (P = .013).

Within the PsA cohort, headache incidence correlated with increased tender and swollen joints and higher LEI and Health Assessment Questionnaire scores. Marino and colleagues indicated these individuals with a more pronounced burden of PsA symptoms may be more likely to develop headaches.

“These findings should open a new avenue for increasing awareness of the importance of examining the risk of migraine and headache in rheumatologic patients, correlating it with other variables such as an increased cardiovascular risk, and developing effective therapies to treat both conditions,” investigators wrote.

References

1. _{Marino A, Currado D, Altamura C, Vomero M, Berardicurti O, Corberi E, Kun L, Pilato A, Biaggi A, Genovali I, et al. Increased Prevalence of Headaches and Migraine in Patients with Psoriatic Arthritis and Axial Spondyloarthritis: Insights from an Italian Cohort Study. Biomedicines. 2024; 12(2):371. https://doi.org/10.3390/biomedicines12020371}
2. _{Scotti L, Franchi M, Marchesoni A, Corrao G. Prevalence and incidence of psoriatic arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. 2018 Aug;48(1):28-34. doi: 10.1016/j.semarthrit.2018.01.003. Epub 2018 Jan 6. PMID: 29398124.}
3. _{Lipton, R.B.; Stewart, W.F.; Diamond, S.; Diamond, M.L.; Reed, M. Prevalence and Burden of Migraine in the United States: Data from the American Migraine Study II. Headache}