Research Summary: Characterization of chronic overlapping pain conditions in patients with chronic migraine: A CHOIR study

Headache®: The Journal of Head and Face Pain published “Characterization of chronic overlapping pain conditions in patients with chronic migraine: A CHOIR study.” 

There is a set of widespread pain disorders that are often co-occurring within the same individual, including fibromyalgia, irritable bowel syndrome, TMD, migraine headache and low back pain, among many others. Previous studies have linked migraine to many of these non-cephalic pain syndromes, and a recent study suggested that patients with episodic migraine have 43% higher odds of developing chronic migraine for every non-cephalic pain syndrome they experience.

This current study aims to characterize physical and psychosocial functioning of patients with chronic migraine versus those with chronic migraine and chronic overlapping pain conditions (COPCs).

Study Methods

• Data was from the Collaborative Health Outcomes Information Registry (CHOIR), including information from the patients’ first visit at a large tertiary care pain management center and their electronic health records. 
• 1601 patients were included, identified based on diagnosis codes used.
• Patients were asked to look on the CHOIR body map and report non-cephalic areas of pain.
• Patient functioning was assessed via various domains, including depression, anxiety, anger, physical function, pain interference, pain behavior, sleep disturbance, fatigue, social isolation and satisfaction with social roles and activities.
• Other factors measured included pain intensity, pain catastrophizing, medical utilization and adverse life experiences.

Study Results

• 1601 patients with chronic migraine (CM) were included.
• 1131 participants reported pain in one or more areas outside the head; neck and bilateral shoulder regions were the most commonly reported areas with pain.
• The investigators found that there was a linear association between more widespread pain on the body map and significantly worse function across all domains, including average and worse pain intensity, anger, fatigue, depressive and anxious symptoms, sleep disturbance, physical function, social isolation and pain catastrophizing.
• The strongest association was with fatigue and worse physical function.
• There was also an association with more healthcare utilization, including ER visits, overnight hospital stays, etc.
• Those with widespread pain also endured more adverse life experiences.

Implications for Primary Care Clinicians

• There is a distinct subpopulation of patients with CM who also have COPCs or widespread pain syndromes.
• This subgroup of patients seems to have a higher degree of symptom severity and burden.
• The body map can be a useful way to identify this subpopulation.
• It is important to characterize these patients to best provide a multidisciplinary treatment approach to headache and chronic widespread pain in an effort to improve quality of life and restore function.
• A referral to a multi-specialty team would be a great practical solution.

This summary is part of the First Contact – Headache in Primary Care initiative, an American Headache Society program that provides educational resources to empower healthcare professionals and improve headache and migraine care. We encourage providers in all stages of their careers to visit our homepage to access educational tools to improve patient care.