Chronic Migraine (CM) and Chronic Tension-Type Headache Are Associated with Concomitant Frequent Back Pain (P04.260)

Abstract

Objective: To evaluate whether chronic back pain is associated with chronic migraine (CM) and chronic tension-type headache (CTTH) in a large population-based sample in Germany. Background While migraine and tension-type headache have different ethiology and pathophysiology, there is growing evidence that central sensitization of the pain matrix if an important the common pathway of the pathophysiology of chronic headache and chronic pain in general (reference). Design/Methods: We collected information about clinical features and frequency of headache and back pain through mailed questionnaires and phone interviews. Headache and back pain were stratified into episodic (1-14 days/month) and chronic/frequent forms (≥15 days/month). We tested the association between frequent back pain and chronic headache (vs. episodic headache and no headache), CM (vs. episodic migraine, EM vs. no headache) and CTTH (vs. episodic tension-type headache, ETTH vs. no headache). Results: Of 18,000 subjects 9,944 responded (55%). 5616 respondents reported headache in the previous year, of whom 255 had chronic headache. Migraine was diagnosed in 1709 respondents, of whom 108 had CM. TTH was found in 1253 individuals, of whom 50 had CTTH. 6621 respondents complained about low back pain, of whom 1290 reported chronic low back pain. Frequent low back pain was associated with all chronic headaches: with chronic headache (OR 14.5 95%CI [10.7-20.0] vs. episodic headache (OR 2.3 95%CI [2.0-2.7]) vs. no headache, CM (OR 15.8 95%CI [10.2-24.5] vs. EM (OR 2.6 95%CI [2.1-3.2]) vs. no headache and with CTTH (OR 13.7 95%CI [7.4-25.3] vs. ETTH (OR 2.1 95%CI [1.7-2.7]) vs. no headache. Conclusions: Chronic back pain is associated with both, chronic migraine and chronic tension-type headache indicating that neurobiology of chronic headache, independently of the primary headache type involves not only trigeminal pain pathway but rather is a part of abnormal general pain processing. Supported by: The German Federal Minsitry for Education and research. This analysis was supported by Allergan. Disclosure: Dr. Yoon has nothing to disclose. Dr. Manack has received personal compensation for activities with Allergan, Inc. Dr. Fritsche has nothing to disclose. Dr. Obermann has received research support from the German Federal Ministry of Education and Research. Dr. Diener has received personal compensation for activities with Merck, Pharm Allergan GmbH, Almirall, AstraZeneca, Bayer Vital, Berlin Chemie, Coherex Medical, CoLucid, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, and Grenenthal.Dr. Diener has received research support from Merck, Pharm Allergan GmbH, Almirall, AstraZeneca, Bayer Vital, Berlin Chemie, Coherex Medical, CoLucid, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Grenenthal, Janssen Pharmaceuticals. Dr. Moebus has nothing to disclose. Dr. Katsarava has received personal compensation for activities with Allergan, Inc. as a consultant.