Migraine and chronic daily headache (CDH) may be risk factors for the development of complex regional pain syndrome (CRPS), according to the results of a study led by B. Lee Peterlin, DO, assistant professor of neurology, Drexel University College of Medicine in Philadelphia.1 According to Dr Peterlin, these results strongly suggest that physicians should aggressively treat patients with migraine and CDH to limit disability from headaches as well as progression to an even more disabling pain syndrome, CRPS.
Dr Peterlin and colleagues found that patients with CRPS were 3.6 times more likely to have migraine than persons in the general population. The study included 124 patients who fulfilled the International Association for the Study of Pain criteria for CRPS; 99 were women and the mean participant age was 45.5 years. Of these patients, 78 met the International Classification of Headache Disorders, 2nd edition, criteria for definitive (92.8%) or probable (7.2%) migraine, and 74 experienced aura. Of the migraineurs, 61.2% reported having severe headaches before CRPS symptom onset.
Study results also showed that symptoms of CRPS may be more likely to develop at a much earlier age in patients with CRPS and migraine or CDH compared with those without migraine or only tension-type headache (TTH). The mean age of CRPS onset was 34.9 years in patients with migraine and 32.5 years in patients with CDH. However, the mean age of CRPS onset was 46.8 years in those without headache and 39.9 years in those with TTH. Moreover, the mean duration of CRPS was 10.1 years in patients with migraine but was only 5.8 years in those without headache or who had experienced only TTH.
In addition to earlier development of CRPS, those with migraine may also have a more severe form of CRPS, according to Dr Peterlin. Migraineurs reported a greater number of affected extremities (median, 4 extremities) compared with those without migraine or with TTH (median, 2 extremities). Patients with migraine were also more likely to have experience static, dynamic, and deep joint mechano-allodynia compared with persons without headache or with TTH (72.2% vs 46.2%, respectively).
Dr Peterlin said the results of this study confirm the findings of other recent reports showing that patients with CRPS may be more likely to experience headache or migraine.2,3 However, the causes of migraine and CRPS remain unknown and warrant further investigation, she said.
Dr Peterlin concluded that in young patients with migraine, physicians should be on the lookout for the development of CRPS symptoms. In addition, she suggests that patients with CRPS and migraine or CDH should be treated with medications that can effectively manage both illnesses.
1. Peterlin BL, Rosso AL, Nair S, et al. Evidence that migraine may be a risk factor for the development of complex regional pain syndrome. Presented at: the International Headache Conference; September 10-13, 2009; Philadelphia. Abstract.
2. Toda K, Muneshige H, Maruishi M, et al. Headache may be a risk factor for complex regional pain syndrome. Clin Rheumatol. 2006;25:728-730.
3. de Mos M, Huygen FJ, Dieleman JP, et al. Medical history and the onset of complex regional pain syndrome (CRPS). Pain. 2008;139:458-466.