There is increased prevalence of migraine in individuals who have rheumatologic disorders, including Sjo”gren’s syndrome (Pal et al., 1989) and systemic lupus erythematosus (Isenberg et al., 1982). Several case series (Miller et al., 1981; Atkinson and Appenzeller, 1976; O’Keeffe et al., 1992, 1993; Pal et al., 1989; Isenberg et al., 1982; Leppert et al., 1987; Zahavi et al., 1984) have suggested that migraine is comorbid with Raynaud’s phenomenon (RP). Zahavi et al. (1984) found an increased prevalence of RP in migraineurs. O’Keeffe et al. (1992) found an increased prevalence of migraine and chest pain in a sample of patients with primary RP. In a follow-up study, O’Keeffe et al. (1993) found an increased prevalence of migraine in a group of patients with RP compared with controls. Miller et al. (1981) found an increased prevalence of both migraine and RP in patients with variant angina. Leppert et al. (1987) found a high prevalence of recurrent headaches in a population of women with RP. Terwindt et al. (2000) found a genetic link between migraine, RP, and vascular retinopathy in one extended Dutch family. Finding a gene for this family may help to elucidate the genetic background of migraine and other vascular disorders indicating RP.
Migraine And Essential Tremor
A cross-sectional study conducted by Biary et al. (1990) found a relationship between essential tremor and migraine. Patients were identified from either a movement disorder clinic or a headache clinic. Controls were selected from students, hospital staff, and visitors. The prevalence of migraine among patients with essential tremor was 36% compared with 23% in the control group. The prevalence of essential tremor was 17% among patients with migraine compared with 6% in the control group. In a regression analysis controlling for age and gender, the odds of migraine were 12.1 times higher in essential tremor patients compared with controls. A similar regression analysis found the odds of essential tremor to be 16.2 times greater among migraine patients compared with controls. This one small study, while limited, suggests that two common neurologic disorders, migraine and essential tremor, may be associated. Beta blockers have been effective at
treating both conditions (Winkler and Young, 1974; Weber and Reinmuth, 1972).
Several disorders are strongly associated with migraine headache in both clinical samples and the general population. The strongest associations have been observed between migraine and stroke, migraine and epilepsy, and migraine and psychiatric disease. Studies of comorbidity are important in clinical practice because they enforce the need for heightened diagnostic suspicion. In addition, comorbidity influences choice of therapy, imposing limitations due to contraindications and opportunities to treat two conditions with a single agent. Future studies need to be designed to specifically investigate patterns and causes of comorbidity in migraine and other diseases using standardized diagnostic definitions and reliable methods of ascertainment of both migraine and the comorbid condition. Ultimately, identification of comorbidities should yield insights into the pathophysiology of migraine.
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Aaron L Shechter
Richard B Lipton
Stephen D Silberstein
Editors: Silberstein, Stephen D.; Lipton, Richard B.; Dalessio, Donald J.