Daily Dose: Fatigue More Common in Chronic vs Episodic Migraine

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in the Journal of Neurosciences in Rural Practice.

The study

Researchers conducted a cross-sectional observational study to refine current understanding of the prevalence and severity of both fatigue and chronic fatigue syndrome (CFS) in patients with episodic vs chronic migraine—the study’s primary objective. The secondary objectives were to explore the relationship of fatigue with conditions that are often comorbid with migraine, including fibromyalgia, depression, and anxiety.

Adults aged at least 18 years were recruited from the Neurology Outpatient Department, GIPMER, a tertiary neurology referral center in New Delhi, India, between February 2019 to July 2020. The final cohort numbered 60 participants, 30 each with episodic and chronic migraine.

Headache severity was assessed using the Headache Impact Test-6 (HIT-6) score; measures of fatigue were evaluated using the Fatigue Severity Scale (FSS), the Chalder Fatigue Scale, and the Centers for Disease Control and Prevention’s diagnostic criteria for chronic fatigue syndrome.

Findings

Mean total duration of migraines was higher in patients with chronic migraine compared with episodic migraine (10.1 ± 7.59 vs 6.97 ± 4.74 years, respectively; P = .06). In addition, mean headache frequency was significantly higher in the chronic migraine cohort compared with the episodic group (23.02 days/month, range 15–30 days vs 7.76 days/month, range: 2–15 days, respectively; P<.001).

Of interest, more than half of participants with episodic migraine (53.3%) had a positive family history of migraine vs 33.3% of those with chronic migraine, although the difference did not reach significance.

As had been expected, the mean HIT-6 score was significantly higher in patients with chronic migraine (59.43 ± 6.74) compared with episodic migraine (53.2 ± 8.41) (P=.002).

When researchers compared the 2 groups on measures of fatigue, they found those with chronic migraine had a higher mean FSS score (47.87 vs 37.3, respectively; P=.004). A severe FSS score was recorded in 60% of the chronic vs 20% of the episodic migraineurs (P=.004).

Authors' comment

"Migraineurs need to be assessed and treated for their headache and associated co-morbid disorders which may account for the poor response to treatment...Awareness of migraine related fatigue will help formulate the optimal treatment strategy in an otherwise chronic disabling disorder that requires not only medical therapy for headache but also targeted management of fatigue and its related comorbidities besides psychosocial intervention and support for best results."

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