Prevalence and Association of Lifestyle and Medical-, Psychiatric-, and Pain-related Comorbidities in Patients With Migraine

A Cross-sectional Study

Jiu-Haw Yin MD; Yu-Kai Lin MD; Chun-Pai Yang MD, PhD; Chih-Sung Liang MD; Jiunn-Tay Lee MD; Meei-Shyuan Lee PhD; Chia-Lin Tsai MD; Guan-Yu Lin MD; Tsung-Han Ho MD; Fu-Chi Yang MD, PhD

Disclosures

Headache. 2021;61(5):715-726. 

In This Article

Results

Participant Characteristics

Table 1 lists the characteristics of the migraine and non-migraine control groups. Comparisons between the two groups revealed that the migraine patients had a greater female predominance, were younger, and had a lower BMI than the control participants (p < 0.001). No significant differences were observed in educational level, marital status, or employment status. The migraine group was further split into the episodic migraine (<15 days/month) and chronic migraine (≥15 days/month) subgroups. Subgroup analyses revealed that the prevalence of aura was higher in the chronic migraine subgroup (43.4% [135/311] vs. 31.3% [296/946], p < 0.001). In addition, the educational level was lower in the chronic migraine subgroup (p < 0.001). The proportions of those who are divorced/widowed and retired or running a household were also higher in the chronic migraine subgroup (Table 1).

Comorbid Conditions of Migraine

Table 2 summarizes migraine comorbidities separated by migraine chronicity. After adjustment of covariates (sex, age, BMI, educational level, marital status, and employment status), results revealed that the prevalence of thyroid disease (p = 0.006), peptic ulcer disease (p = 0.015), mitral valve prolapse (p = 0.020), depression (p = 0.031), anxiety (p < 0.001), insomnia (p < 0.001), subjective memory complaints (p < 0.001), fibromyalgia (p = 0.006), irritable bowel syndrome (p = 0.004), chronic fatigue syndrome (p < 0.001), and glaucoma (p = 0.035) was significantly higher in the migraine group than in the control group. The detailed information of adjusted odds ratio and 95% confidence interval (CI) are provided in Figure 1. Regarding the comparison between the episodic and chronic migraine subgroups, the results suggested that chronic migraine was associated with higher risks of peptic ulcer disease (p = 0.007), mitral valve prolapse (p = 0.001), asthma (p = 0.025), depression (p < 0.001), anxiety (p < 0.001), insomnia (p < 0.001), subjective memory complaints (p < 0.001), fibromyalgia (p < 0.001), irritable bowel syndrome (p = 0.004), and chronic fatigue syndrome (p < 0.001) (Table 2). The detailed information of adjusted odds ratio and 95% CI are provided in Figure 2.

Figure 1.

The association between migraine and risks of lifestyle variables and comorbid diseases of migraine. The odds ratios were adjusted for sex, age, body mass index, educational level, marital status, and employment status. CI, confidence interval; OR, odds ratio [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2.

The association between attack frequency of migraine and risks of lifestyle variables and comorbid diseases of migraine in patients with migraine. The odds ratios were adjusted for sex, age, body mass index, educational level, marital status, and employment status. CI, confidence interval; OR, odds ratio [Color figure can be viewed at wileyonlinelibrary.com]

Comorbidities Between Migraine and Control Groups, Stratified by Aura

Table 3 summarizes the conditions comorbid with migraine between the migraine and control groups stratified by aura. The results demonstrated that there were significantly more current smokers in the migraine with aura group compared with the non-migraine control group (15.5% vs. 11.5%, p = 0.013). Conversely, the prevalence of ever smokers was lower in the migraine with aura when compared with the control participants (23.9% vs. 24.4%, p = 0.046). The prevalence of thyroid disease (p = 0.007), peptic ulcer disease (p = 0.001), mitral valve prolapse (p = 0.001), depression (p = 0.014), anxiety (p < 0.001), insomnia (p < 0.001), subjective memory complaints (p < 0.001), fibromyalgia (p < 0.001), dysmenorrhea (p = 0.003), irritable bowel syndrome (p < 0.001), chronic fatigue syndrome (p < 0.001), and glaucoma (p = 0.022) was significantly higher in the group of patients with migraine with aura than in the control group.

There were no significant group differences in lifestyle factors of smoking, or drinking alcohol or coffee between the patients with migraine without aura and the control participants (Table 3). However, the results showed that migraine without aura was associated with greater risks of thyroid disease (p = 0.024), anxiety (p = 0.001), insomnia (p < 0.001), subjective memory complaints (p < 0.001) and chronic fatigue syndrome (p < 0.001). There were more significant associations with comorbidities in the aura compared with the non-aura group.

Comorbidities Between the Migraine and Control Groups, Stratified by Sex

Table 4 summarizes the conditions comorbid with migraine between the migraine and control groups stratified by sex. The results revealed that the prevalence of thyroid disease (p = 0.010), peptic ulcer disease (p = 0.043), mitral valve prolapse (p = 0.035), anxiety (p < 0.001), insomnia (p < 0.001), subjective memory complaints (p < 0.001), irritable bowel syndrome (p = 0.034), and chronic fatigue syndrome (p < 0.001) was significantly higher in the female patients with migraine than in the female control participants. Among men, migraine was associated with higher risks of anxiety (p = 0.013), insomnia (p < 0.001), subjective memory complaints (p < 0.001), and chronic fatigue syndrome (p < 0.001). In general, there were a greater number of significant items among females than males. There were more significant associations with comorbidities among female patients with migraine than among male patients with migraine.

Comorbidities Between Patients With Migraine With and Without Aura

Figure S1 summarizes the comorbid conditions of migraine between patients with migraine with and without aura. After adjustment of the aforementioned covariates, the results demonstrated that the prevalence rates of peptic ulcer disease (p = 0.003), mitral valve prolapse (p = 0.001), asthma (p = 0.040), anxiety (p < 0.001), insomnia (p < 0.001), subjective memory complaints (p < 0.001), fibromyalgia (p < 0.001), dysmenorrhea (p = 0.021), irritable bowel syndrome (p = 0.003), chronic fatigue syndrome (p < 0.001), and glaucoma (p = 0.032) were significantly higher in the patients with migraine with aura than in the patients with migraine without aura.

Comorbidities Between Female and Male Patients With Migraine

Figure S2 summarizes the comorbid conditions of migraine between female and male patients with migraine. The results showed that the proportions of ever smokers (p < 0.001), current smokers (p < 0.001), non-frequent drinkers (p < 0.001), and frequent drinkers (p = 0.002) were higher among male than female patients with migraine. Regarding the medical conditions, the prevalence of hypertension (p < 0.001) was significantly higher among male than female patients with migraine. However, females were more likely to have thyroid disease (p = 0.001), peptic ulcer disease (p = 0.034), mitral valve prolapse (p = 0.006), anxiety (p = 0.018), fibromyalgia (p = 0.011), irritable bowel syndrome (p < 0.001), and chronic fatigue syndrome (p = 0.004).

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