Abstract
BackgroundHeadaches are more frequent in Chronic Fatigue Syndrome (CFS) than healthy control (HC) subjects. The 2004 International Headache Society (IHS) criteria were used to define CFS headache phenotypes.MethodsSubjects in Cohort 1 (HC = 368; CFS = 203) completed questionnaires about many diverse symptoms by giving nominal (yes/no) answers. Cohort 2 (HC = 21; CFS = 67) had more focused evaluations. They scored symptom severities on 0 to 4 anchored ordinal scales, and had structured headache evaluations. All subjects had history and physical examinations; assessments for exclusion criteria; questionnaires about CFS related symptoms (0 to 4 scale), Multidimensional Fatigue Inventory (MFI) and Medical Outcome Survey Short Form 36 (MOS SF-36).ResultsDemographics, trends for the number of diffuse "functional" symptoms present, and severity of CFS case designation criteria symptoms were equivalent between CFS subjects in Cohorts 1 and 2. HC had significantly fewer symptoms, lower MFI and higher SF-36 domain scores than CFS in both cohorts. Migraine headaches were found in 84%, and tension-type headaches in 81% of Cohort 2 CFS. This compared to 5% and 45%, respectively, in HC. The CFS group had migraine without aura (60%; MO; CFS+MO), with aura (24%; CFS+MA), tension headaches only (12%), or no headaches (4%). Co-morbid tension and migraine headaches were found in 67% of CFS. CFS+MA had higher severity scores than CFS+MO for the sum of scores for poor memory, dizziness, balance, and numbness ("Neuro-construct", p = 0.002) and perceived heart rhythm disturbances, palpitations and noncardiac chest pain ("Cardio-construct"; p = 0.045, t-tests after Bonferroni corrections). CFS+MO subjects had lower pressure-induced pain thresholds (2.36 kg [1.95-2.78; 95% C.I.] n = 40) and a higher prevalence of fibromyalgia (47%; 1990 criteria) compared to HC (5.23 kg [3.95-6.52] n = 20; and 0%, respectively). Sumatriptan was beneficial for 13 out of 14 newly diagnosed CFS migraine subjects.ConclusionsCFS subjects had higher prevalences of MO and MA than HC, suggesting that mechanisms of migraine pathogenesis such as central sensitization may contribute to CFS pathophysiology.Clinical Trial RegistrationGeorgetown University IRB # 2006-481ClinicalTrials.gov NCT00810329
Highlights
Headaches are more frequent in Chronic Fatigue Syndrome (CFS) than healthy control (HC) subjects
Demographics, Disability, and Fatigue There were no significant differences in age or gender distribution between HC and CFS subjects in either Cohort 1 or Cohort 2 after Bonferroni corrections of p values (Table 1)
There were no significant differences of age, gender, or body mass index (BMI) for Cohort 2 HC and the CFS plus headache subtypes
Summary
Headaches are more frequent in Chronic Fatigue Syndrome (CFS) than healthy control (HC) subjects. The 2004 International Headache Society (IHS) criteria were used to define CFS headache phenotypes. The characteristics of these headaches are poorly defined with regards to the International Headache Society criteria (IHS) [3]. The CFS case designation requires a 6 month history of persistent, unexplained fatigue that causes significant impairment of activity, plus 4 of 8 associated criteria [1]. These criteria include exertional exhaustion, cognitive and sleep disturbances, and diffuse bodily pain including headaches. Headache severity was assessed by a 5 point ordinal scale [4]. Surgical and psychiatric conditions were ruled out by history and physical examinations
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