Headache, Migraines, Obesity and Medication Burden on Fibromyalgia Impact and Quality of Life

Main Article Content

Youssef Abdullah Rija Aziz Michelle M Osuna Diaz Lianbo Yu Silvia de Lamo Castellvi Katherine R. Sebastian M. Monica Giusti Luis Rodriguez-Saona Kevin V. Hackshaw

Abstract

Fibromyalgia (FM) is a common, complex, and chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. A multitude of other central sensitization related symptoms contribute to a profound medication burden and diminished quality of life for affected individuals. We evaluated the impacts of gender, chronicity of  headache, migraine, obesity and medication burden on overall FM impact. We used the following validated questionnaires: Fibromyalgia Impact Questionnaire (FIQR), Beck Depression Inventory (BDI), Central Sensitization Inventory (CSI) and measured weight and body mass index (BMI) on a large university cohort of FM subjects. We found that female subjects with FM showed a significant increase in FIQR compared to males with FM. Additionally, we noted positive correlations between weight (Wt) and FIQR, BDI and CSI; BMI and FIQR, and BMI and CSI. Fibromyalgia subjects with a history of migraines (FM-migraine) showed statistically significant increases in FIQR, BDI and CSI compared to FM subjects with no reported history of migraines (FM-non-migraine). There was a steady increase in FIQR, BDI and CSI values with an increase in the frequency of headaches in both the FM -migraine and FM -non-migraine groups. When evaluating BMI, when comparing survey responses of overweight and obese patients to normal weight patients, all FIQR, BDI and CSI values were significantly increased in the various classes of overweight except CSI for the overweight category which appeared to approach significance (p=0.057). There were no statistically significant differences in questionnaire responses for individuals with FM on medications relative to those on no medications. Taken together, a history of migraines and headaches, frequency of headaches and obesity may impact survey responses significantly, negatively impact quality of life and correlate with higher levels of depression but medication burden did not.

Keywords: Fibromyalgia, central sensitization, migraine, headache, obesity, medication burden

Article Details

How to Cite
ABDULLAH, Youssef et al. Headache, Migraines, Obesity and Medication Burden on Fibromyalgia Impact and Quality of Life. Medical Research Archives, [S.l.], v. 12, n. 4, apr. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5239>. Date accessed: 27 may 2024. doi: https://doi.org/10.18103/mra.v12i4.5239.
Section
Research Articles

References

1. Häuser, W.; Ablin, J.; Fitzcharles, M.-A.; Littlejohn, G.; Luciano, J. V.; Usui, C.; Walitt, B. Fibromyalgia. Nat Rev Dis Primers 2015, 1, 15022, Doi:10.1038/nrdp.2015.22.
2. Yunus, M.B. Central sensitivity syndromes: A new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Semin. Arthritis Rheum. 2008, 37, 339–352. [CrossRef]
3. Woolf, C.J. Central sensitization: Implications for the diagnosis and treatment of pain. Pain 2011, 152, S2–S15. [CrossRef]
4. Clauw, D.J.; Hassett, A.L. The role of centralised pain in osteoarthritis. Clin. Exp. Rheumatol. 2017, 35 (Suppl. 107), 79–84.
5. Melzack, A.R.; Wall, P.D. Pain mechanisms: A new theory. Science 1965, 150, 971–979. [CrossRef]
6. Burgess, P.R.; Perl, E.R. Myelinated afferent fibres responding specifically to noxious stimulation of the skin. J. Physiol. 1967, 190, 541–562. [CrossRef]
7. Perl, E.R. Myelinated afferent fibres innervating the primate skin and their response to noxious stimuli. J. Physiol. 1968, 197, 593–615. [CrossRef] [PubMed]
8. Bessou, P.; Perl, E.R. Response of cutaneous sensory units with unmyelinated fibers to noxious stimuli. J. Neurophysiol. 1969, 32, 1025–1043. [CrossRef] [PubMed]
9. Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum. 2007 Jun;36(6):339-56. doi: 10.1016/j.semarthrit.2006.12.009. Epub 2007 Mar 13. PMID: 17350675. [CrossRef]
10. Borsook D, Edwards R, Elman I, Becerra L, Levine J. Pain and analgesia: The value of salience circuits. Progress in Neurobiology,Vol 104, 2013, 93-105. ISSN 0301-0082, https://doi.org/10.1016/j.pneurobio.2013.02.003.
11. Benlidayi C, I. Role of inflammation in the pathogenesis and treatment of fibromyalgia. Rheumatol Int 2019, 39, 781–791 https://doi.org/10.1007/s00296-019-04251-6
12. Martínez-Lara A, Moreno-Fernández AM, Jiménez-Guerrero M, Díaz-López C, De-Miguel M, Cotán D, Sánchez-Alcázar JA. Mitochondrial Imbalance as a New Approach to the Study of Fibromyalgia. Open Access Rheumatol. 2020 Aug 24;12:175-185. doi: 10.2147/OARRR.S257470. PMID: 32922097; PMCID: PMC7455536.
13. Littlejohn, G., Guymer, E. Neurogenic inflammation in fibromyalgia. Semin Immunopathol 2018, 40, 291–300 https://doi.org/10.1007/s00281-018-0672-2
14. Oaklander AL, Herzog ZD, Downs HM, et al. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain. 2013;154(11):2310–2316
15. Levine T, Saperstein DS, Levine A, Hackshaw KV, Lawson V. Small fiber neuropathy in patients meeting diagnostic criteria for fibromyalgia. J Neurol Disord. 2016;4(7):7. Doi: 10.4172/2329-6895.1000305
16. Lodahl M, Treister R, Oaklander AL. Specific symptoms may discriminate between fibromyalgia patients with vs without objective test evidence of small-fiber polyneuropathy. Pain Rep. 2017 Dec 16;3(1):e633. Doi: 10.1097/PR9.0000000000000633. PMID: 29430562; PMCID: PMC5802321.
17. Oaklander AL, Nolano M. Scientific Advances in and Clinical Approaches to Small-Fiber Polyneuropathy: A Review. JAMA Neurol. 2019;76(10):1240–1251. Doi:10.1001/jamaneurol.2019.2917
18. Lawson VH, Grewal J, Hackshaw KV, Mongiovi PC, Stino AM. Fibromyalgia syndrome and small fiber, early or mild sensory polyneuropathy. Muscle Nerve. 2018 Nov;58(5):625-630. Doi: 10.1002/mus.26131
19. Hurtig IM, Raak RI, Kendall SA, et al.: Quantitative sensory testing in fibromyalgia patients and in healthy subjects: identification of subgroups. Clin J Pain 2001, 17:316–322..
20. Sorensen J, Graven-Nielsen T, Henriksson -G, et al.: Hyperexcitability in fibromyalgia. J Rheumatol 1998, 25:152–155.
21. Gobel H, Weigle L, Kropp P, Soyka D: Pain sensitivity and pain reactivity of pericranial muscles in migraine and tension-type headache. Cephalalgia 1992, 12:142–151.
22. Jensen R, Rasmussen BK, Pedersen B, Olesen J: Muscle tenderness and pressure pain thresholds in headache. A population study. Pain 1993, 52:193–199.
23. Sarchielli, P., Di Filippo, M., Nardi, K. et al. Sensitization, glutamate, and the link between migraine and fibromyalgia. Current Science Inc 2007, 11, 343–351. https://doi.org/10.1007/s11916-007-0216-2.
24. Giamberardino, M.A., Affaitati, G., Martelletti, P. et al. Impact of migraine on fibromyalgia symptoms. J Headache Pain 2016, 17, 28. https://doi.org/10.1186/s10194-016-0619-8].
25. Ray JC, Matharu M, Hutton E. Relationship of migraine and other forms of chronic pain. Handb Clin Neurol. 2024, 199:517-524. Doi: 10.1016/B978-0-12-823357-3.00027-6. PMID: 38307668.
26. Varrassi G, Rekatsina M, Perrot S, Bouajina E, Paladini A, Coaccioli S, Narvaez Tamayo MA, Sarzi Puttini P. Is Fibromyalgia a Fashionable Diagnosis or a Medical Mystery? Cureus. 2023 Sep 7;15(9):e44852. Doi: 10.7759/cureus.44852. PMID: 37809234; PMCID: PMC10560069.
27. Kumar H, Dhamija K, Duggal A, Khwaja GA, Roshan S. Fatigue, chronic fatigue syndrome and migraine: Intersecting the lines through a cross-sectional study in patients with episodic and chronic migraine. J Neurosci Rural Pract. 2023 Jul-Sep;14(3):424-431. Doi: 10.25259/JNRP_63_2022. Epub 2023 Apr 20. PMID: 37692810; PMCID: PMC10483198.
28. Lau, Chi-Ieong, et al. Increased risk of chronic fatigue syndrome in patients with migraine: A retrospective cohort study. Journal of Psychosomatic Research 2015, 79.6 : 514-518.
29. Henningsen P, Hausteiner-Wiehle C, Häuser W. Migraine in the context of chronic primary pain, chronic overlapping pain disorders, and functional somatic disorders: A narrative review. Headache. 2022 Nov;62(10):1272-1280. Doi: 10.1111/head.14419.
30. Hackshaw, KV.; Yao, S.; Bao, H.; De Lamo Castellvi, S.; Aziz, R.; Nuguri, S.M.; Yu, L.; Osuna-Diaz, M.M.; Brode, W.M.; Sebastian, K.R.; Giusti, M.M., Rodriguez-Saona L. Metabolic Fingerprinting for the Diagnosis of Clinically Similar Long COVID and Fibromyalgia using a Portable FT-MIR Spectroscopic Combined with Chemometrics. Biomedicines 2023, 11, 2704
31. Yao, S.; Bao, H.; Nuguri, S.M.; Yu, L.; Mikulik, Z.; Osuna-Diaz, M.M.; Sebastian, K.R.; Hackshaw, K.V.; Rodriguez-Saona, L. Rapid Biomarker-Based Diagnosis of Fibromyalgia Syndrome and Related Rheumatologic Disorders by Portable FT-IR Spectroscopic Techniques. Biomedicines 2023, 11, 712.
32. Hackshaw KV, Rodriguez-Saona L, Plans M, Bell LN, Buffington CAT. A bloodspot-based diagnostic test for fibromyalgia syndrome and related disorders. Analyst. 2013;138:4453–62.
33. Hackshaw, K. V., D. P. Aykas, G. T. Sigurdson, M. P. Pujolras, F. Madiai, L. Yu, C. Buffington, M. M. Giusti and L. Rodriguez-Saona "Metabolic fingerprinting for diagnosis of fibromyalgia and other rheumatologic disorders." Journal of 9iological Chemistry 2019, 294(7): 2555-2568.
34. Nuguri, S.M.; Hackshaw, KV.; de Lamo Castellvi, S.; Bao, H.; Yao, S.; Aziz, R.; Selinger, S.; Mikulik, Z.; Yu, L.; Osuna-Diaz, M.M.; et al. Portable Mid-Infrared Spectroscopy Com-bined with Chemometrics to Diagnose Fibromyalgia and Other Rheumatologic Syndromes Using Rapid Volumetric Absorptive Microsampling. Molecules 2024, 29, x. https://doi.org/10.3390/xxxxx
35. Bao, H.; Hackshaw, KV.; Castellvi, S.d.L.; Wu, Y.; Gonzalez, C.M.; Nuguri, S.M.; Yao, S.; Goetzman, CM.; Schultz, ZD.; Yu, L.; et al. Early Diagnosis of Fibromyalgia Using Surface-Enhanced Raman Spectroscopy Combined with Chemometrics. Biomedicines 2024, 12, x. https://doi.org/10.3390/xxxxx
36. Mayer TG, Neblett R, Cohen H, Howard KJ, Choi YH, Williams MJ, Perez Y, Gatchel RJ. The development and psychometric validation of the central sensitization inventory. Pain practice : the official journal of World Institute of Pain. Apr 2012;12(4):276-285
37. Bennett RM, Friend R, Jones KD, Ward R, Han BK, et al. The revised fibromyalgia impact questionnaire (FIQR): validation and psychometric properties. Arthritis Research and Therapy. 2009; 11(4):R120
38. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010; 62:600–110.
39. Wolfe F, Smyth HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, Fam AG, Farber SJ, Fiechtner JJ, Franklin CM, Gatter RA, Harnaty D, Lessard J, Lichtbroun AS, Masi AT, Mccain GA, Reynolds WJ, Romano TJ, Russell IJ, Sheon RP. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum. 1990; 33:160–72.
40. Ablin JN, Wolfe F. A Comparative Evaluation of the 2011 and 2016 Criteria for Fibromyalgia. J. Rheum 2017, 170095; Doi: https://doi.org/10.3899/jrheum.170095
41. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Archives of General Psychiatry, 1988, 41, 561 – 571.
42. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. Dec 1988; 56(6):893-897
43. D'Onghia M, Ciaffi J, Ruscitti P, Cipriani P, Giacomelli R, Ablin JN, Ursini F. The economic burden of fibromyalgia: A systematic literature review. Semin Arthritis Rheum. 2022 Oct;56:152060. Doi: 10.1016/j.semarthrit.2022.152060. Epub 2022 Jul 3. PMID: 35849890.
44. Favretti, M., Dolcini, G., Iannuccelli, C., Franculli, D., Gioia, C., Sarzi-Puttini, P., ... & Di Franco, M.. Gender differences in the revised Fibromyalgia Impact Questionnaire: a pilot study. Clinical and Experimental Rheumatology, 2023, 41(6), 1310-1316.
45. Valera-Calero, J. A., Úbeda-D’Ocasar, E., Arias-Buría, J. L., Fernández-de-las-Peñas, C., Gallego-Sendarrubias, G. M., & Cigarán-Méndez, M.. Convergent validity of the central sensitization inventory in women with fibromyalgia: Association with clinical, psychological and psychophysical outcomes. European Journal of Pain, 2022, 26(10), 2141–2151. https://doi.org/10.1002/ejp.2026
46. Whealy, M., Nanda, S., Vincent, A. et al. Fibromyalgia in migraine: a retrospective cohort study. J Headache Pain 2018, 19, 61 . https://doi.org/10.1186/s10194-018-0892-9
47. Yancy WS Jr, Olsen MK, Westman EC, Bosworth HB, Edelman D: Relationship between obesity and health-related quality of life in men. Obes Res 2002, 10:1057-1064.
48. Sach TH, Barton GR, Doherty M, Muir KR, Jenkinson C, Avery AJ: The relationship between body mass index and health-related quality of life: Comparing the EQ-5D, EuroQol VAS and SF-6D. Int J Obes 2007, 31:189-196
49. Anderson RE, Crespo CJ, Bartlett SJ, Bathon JM, Fontaine KR: Relationship between body weight gain and significant knee, hip, and back pain in older Americans. Obes Res 2003, 11: 1159-1162, 2003
50. Hitt HC, McMillen RC, Thornton-Neaves T, Koch K, Cosby AG. Comorbidity of obesity and pain in a general population: results from the Southern Pain Prevalence Study. J Pain. 2007 May;8(5):430-6. Doi: 10.1016/j.jpain.2006.12.003.
51. Okifuji A, Donaldson GW, Barck L, Fine PG. Relationship between fibromyalgia and obesity in pain, function, mood, and sleep. J Pain. 2010 Dec;11(12):1329-37. Doi: 10.1016/j.jpain.2010.03.006.
52. Mathkhor AJ, Ibraheem NM. Prevalence and Impact of obesity on fibromyalgia syndrome and its allied symptoms. J Family Med Prim Care. 2023 Jan;12(1):123-127. Doi: 10.4103/jfmpc.jfmpc_2052_22.
53. Núñez-Nevárez K, López-Betancourt A, Cisneros-Pérez V, Rodríguez-Márquez CN, Galvan GZ, Luis AC, Escorza MAQ. Relationship Between Weight and Severity of Fibromyalgia. Mo Med. 2023, Jan-Feb;120(1):83-88. PMID: 36860603; PMCID: PMC9970337
54. Robinson RL, Kroenke K, Mease P, Williams DA, Chen Y, D'Souza D, Wohlreich M, McCarberg B. Burden of illness and treatment patterns for patients with fibromyalgia. Pain Med. 2012 Oct;13(10):1366-76. doi: 10.1111/j.1526-4637.2012.01475.x. Epub 2012 Sep 7. PMID: 22958298. https://doi.org/10.1111/j.1526-4637.2012.01475.x