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Migraine Comorbidity Constellations
Tietjen GE, Herial NA, et al.
Posted: August 2007  
Headache 2007;47:857-865

Objectives:   To identify distinct constellations of comorbid disorders occurring in migraineurs, and to examine differences in demographics, headache profiles, and psychosocial features between the comorbidity constellations.

Methods:   This is a retrospective electronic chart review of consecutive new female outpatients diagnosed with migraine. Questionnaires collected information on comorbid diagnoses, current depression, somatic symptoms, psychosocial stressors, and antidepressant use, social and abuse history. Cluster analysis, based on nonheadache disorders, was performed and differences between the resulting groups were examined.

Results:   We identified 3 groups. Group 1 was defined by hypertension, hyperlipidemia, diabetes mellitus, and hypothyroidism; Group 2 by depression, anxiety, and fibromyalgia; Group 3 by the absence of defining comorbidities. Group 1 had more males, was older, and had later age of headache onset. Group 2 had the greatest disability, and the lowest quality of life. Persons in Group 2 more commonly reported sexual abuse, physical abuse, and emotional abuse.

Conclusion:   Within a headache clinic population, we identified 3 different migraine comorbidity constellations, with differing headache and psychosocial profiles, suggesting heterogeneity of genetic and environmental factors. This may have implications for diagnosis and disease management.