Saturday, August 22, 2009

Migraine Headache a Risk Factor for CRPS/RSD

Researchers conducted a cross-sectional survey study to evaluate the association of migraine headache with complex regional pain syndrome (CRPS). Findings suggest that migraines may be a significant risk factor in some patients for developing more severe forms of CRPS and at a younger age, which recommends the early diagnosis and aggressive management of these chronic headaches.

CRPS, also known as Reflex Sympathetic Dystrophy (RSD), and migraine headache are chronic, often disabling pain syndromes. CRPS, characterized by severe and relentless pain, affects up to 1.2 million Americans and occurs 2 to 3 times more frequently in women than men [more info here]. About 30 million Americans are afflicted with migraines, occurring 3 times more often in women. Migraine is often misdiagnosed as sinus headache or tension-type headache, with fewer than half of all sufferers receiving an accurate diagnosis of migraine and appropriate treatment [more info].

It has been previously observed that there is an unusually high prevalence of cooccurring migraine headaches in patients with CRPS. To further examine this relationship, B. Lee Peterlin, DO, and colleagues conducted an extensive survey in 124 outpatients with diagnosed CRPS at a pain clinic in the Philadelphia, Pennsylvania area. Most of the subjects were female (80%) and white (91%), averaging about 45 years of age. Of the total participants, 89% reported headaches within the past year and 63% fulfilled criteria for migraine headache. Compared with the prevalence in the general population, these patients with CRPS were 3.6 times more likely to have migraine headaches. Additionally, the presence of aura was reported in a higher percentage of CRPS sufferers with migraine, 60%, than is typically reported in the general population of migraineurs.

Investigators also found that the presence of migraine appeared to be associated with more severe CRPS (eg, pain symptoms present in more extremities). Most of the migraineurs in this study reported having experienced any headaches (81%) or severe headaches (61%) in advance of developing CRPS, and the onset of CRPS was reported at a significantly earlier age in those patients with migraine (mean 35 years of age) than in CRPS-afflicted patients without headaches (mean age 47).

Clinical Perspectives: Based on their data, the investigators conclude that migraine headaches may be a risk factor for developing severe forms of CRPS and at an earlier age than is typical. However, the possible mechanisms influencing this relationship are not clear, and this sort of study cannot confirm that migraine headaches actually cause the development of CRPS. Still, the authors recommend that, in view of the implied risk, aggressive early management of patients suffering from migraine may be warranted. Whether or not such treatment would prevent or forestall development of CRPS is unknown and needs further research, and the study authors do not discuss any particular migraine therapy. Finally, since the presence of aura was reported in a high percentage of migraineurs with CRPS, and since migraine with aura has been associated with increased risk of vascular disease — ischemic stroke, myocardial infarction, angina — assessments of cardiovascular risk profiles could be appropriate in dually-afflicted patients having migraine with aura and CRPS. To confirm the findings of this study, further research on the relationships of migraine and CRPS/RSD should be conducted in larger, more diverse populations of patients.

Reference: Peterlin BL, Rosso AL, Nair S, Young WB, Schwartzman RJ. Migraine may be a risk factor for the development of complex regional pain syndrome. Cephalalgia. 2009(August). Online ahead of print [see full article PDF]. Sources of funding for this study or conflicts of interest were not reported in the journal.