Migraine in gulf war illness and chronic fatigue syndrome: prevalence, potential mechanisms, and evaluation

Rakib U Rayhan,Murugan K Ravindran,James N Baraniuk

doi:10.3389/fphys.2013.00181

Abstract

Objective: To assess the prevalence of headache subtypes in Gulf War Illness (GWI) and Chronic Fatigue Syndrome (CFS) compared to controls.Background: Approximately, 25% of the military personnel who served in the 1990–1991 Persian Gulf War have developed GWI. Symptoms of GWI and CFS have considerable overlap, including headache complaints. Migraines are reported in CFS. The type and prevalence of headaches in GWI have not been adequately assessed.Methods: 50 GWI, 39 CFS and 45 controls had structured headache evaluations based on the 2004 International Headache Society criteria. All subjects had history and physical examinations, fatigue and symptom related questionnaires, measurements of systemic hyperalgesia (dolorimetry), and assessments for exclusionary conditions.Results: Migraines were detected in 64% of GWI (odds ratio = 11.6 [4.1–32.5]) (mean [±95% CI]) and 82% of CFS subjects (odds ratio = 22.5 [7.8–64.8]) compared to only 13% of controls. There was a predominance of females in the CFS compared to GWI and controls. However, migraine status was independent of gender in GWI and CFS groups (x2 = 2.7; P = 0.101). Measures of fatigue, pain, and other ancillary criteria were comparable between GWI and CFS subjects with and without headache.Conclusion: The high prevalence of migraine in CFS was confirmed and extended to GWI subjects. GWI and CFS may share dysfunctional central pathophysiological pathways that contribute to migraine and subjective symptoms. The high migraine prevalence warrants the inclusion of a structured headache evaluation in GWI and CFS subjects, and treatment when present.

Highlights

Gulf War Illness (GWI), known as Chronic Multisymptom Illness (CMI), affects 25–30% of the 697,000 veterans deployed to the 1990–1991 Persian Gulf War (Fukuda et al, 1998; Gray et al, 2002; RAC-GWVI, 2008; Li et al, 2011)
HEADACHE STATUS Migraines were detected in 64% of GWI and 82% of chronic fatigue syndrome (CFS) subjects compared to 13% of controls (P = 5.5 × 10−11; Table 2)
GWI and CFS subjects have a high prevalence of migraine headaches, comparable patterns of systemic and cognitive complaints, and share overlapping phenomenological case designation criteria

Summary

Introduction

Gulf War Illness (GWI), known as Chronic Multisymptom Illness (CMI), affects 25–30% of the 697,000 veterans deployed to the 1990–1991 Persian Gulf War (Fukuda et al, 1998; Gray et al, 2002; RAC-GWVI, 2008; Li et al, 2011). Veterans with GWI suffer from a wide array of symptoms that include headaches, cognitive dysfunction, chronic pain, fatigue, and other complaints (Fukuda et al, 1998; Gray et al, 2002; Li et al, 2011). Gulf War veterans often meet the criteria for chronic fatigue syndrome (CFS) (Fukuda et al, 1994) and fibromyalgia (FM) strongly suggesting overlap in symptoms for GWI and CFS (Wolfe et al, 1990; Peres et al, 2002; Latremoliere and Woolf, 2009; Baraniuk and Zheng, 2010; Wolfe et al, 2010; Ravindran et al, 2011; de Tommaso et al, 2011). The type and prevalence of headaches in GWI have not been adequately assessed

Methods

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Discussion

Conclusion