Comorbidities Poster Presentation

P0423 - A history of migraine headache may not be associated with worse disability or worse neurologic function (ID 1929)

Speakers
  • A. Damian
Authors
  • A. Damian
  • C. Hu
  • K. Fitzgerald
  • E. Mowry
Presentation Number
P0423
Presentation Topic
Comorbidities

Abstract

Background

Migraine headaches are common in people with multiple sclerosis (MS). Whether migraine has a role in MS course or symptom severity is poorly understood.

Objectives

To assess the association between a history of migraine, disability and neurological function in MS patients. Secondly, to evaluate the association between migraine and frequency of MS relapses, and to determine whether migraine co-occurs with other comorbid conditions in MS patients.

Methods

We conducted an observational study of MS patients who completed the MS Performance Test-based (MSPT) (iPad version of the MS Functional Composite) assessment of neurologic function and had a documented diagnosis of migraine in their electronic medical record. Other queried comorbidities included: diabetes, hypertension, dyslipidemia, history of myocardial infarction, sleep apnea, depression and anxiety. We evaluated the association between a positive history of migraines and MS outcomes, including disability (Patient Determined Disease Steps [PDDS]), annualized relapse rate, rate of brain lesion development on MRI, and objective neurological outcomes (walking speed, manual dexterity and processing speed) using generalized linear models adjusting for age, sex, race, employment status, insurance status, BMI and MS subtype/duration. We also tested whether the pre-specified comorbidities were overrepresented in MS-migraineurs vs. MS-non-migraineurs.

Results

We analyzed cross-sectional data from 2017 participants with MS, 336 of whom had one mention of migraine diagnosis in their chart in either the problem list or past medical history, who completed the MSPT. Relative to MS-non-migraineurs, MS-migraineurs tended to be younger (mean age 42.6y[11.7y] vs. 46.6y[12.6y]; p<0.001), and have a history of depression (46.52[7.64] vs 48.16[7.72]; p<0.001), anxiety (50.29[9.08] vs 52.81[8.76]; p<0.01) as measured by NeuroQoL scores, and obstructive sleep apnea (109 [6.5] vs 53[15.8]); p<0.001). MS-migraineurs were less likely to have severe disability (5.4% vs 12%, p<0.003), and did not show differences in objective neurological outcomes such as walking speed, manual dexterity or processing speed. There was similarly no significant difference in annualized relapse rate or rate of new brain lesion development in MS-migraineurs vs non-migraineurs.

Conclusions

Traditional migraine risk factors such as depression, anxiety as well as obstructive sleep apnea were overrepresented in our cohort of MS-migraineurs. A history of migraine was not associated with greater disability. Migraine may not be adequately captured in the electronic medical record when patients are presenting for MS related care. Evidence to date on this topic is conflicting and warrants future longitudinal studies.

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