Role of Hypermobility in Headache and Migraine

A study by the researchers at RNI has been accepted for presentaion at the annual American Headache Society in Boston in June. The authors of the paper are James Barnett, Vernon Rowe, John Hunter, Elizabeth Rowe, Doug Schell, Arlene O’Shea, Dorsey Paul, Mark Varona, Dana Winegarner, Kenneth VanOwen K, and Sophie Fisher

Introduction

    Many patients who come to our Headache Center have joint hypermobility in addition to their headaches, and they often also have sleep problems, joint problems, and symptoms of dysautonomias such as red hands and feet, fatigue, and GI problems.  Because of the high prevalence of these symptoms in our headache patients, we decided to investigate further the relationship between these disorders.

 Methods of the Study

   In this study the charts of 49 consecutive patients with a Beighton hypermobility score ≥ 5 were retrospectively reviewed. The movement of vertebral bodies C3-C7 on weight-bearing flexion and extension X-Rays of the cervical spine was measured and summed to quantify the total cervical spine mobility for each patient.

In addition, sleep studies, called polysomnograms (PSG), were obtained when appropriate to evaluate sleep complaints, and electromyography (EMG) with nerve conduction was carried out for evaluation of symptoms related to pinched nerves in the neck, that is, cervical radiculopathy or peripheral neuropathy.  Lastly, symptoms related to dysautonomia were tabulated. All ± values reflect the standard error of the mean.

 Results of the Study

The patient group consisted of 7 males and 42 females, with an average age of 33.2 ± 2.0, and an average BMI of 26.5 ± 1.1. Seventy-three percent (73%) of patients possessed a current diagnosis or medical history of headache or migraine, 83% had symptoms referable to autonomic nervous system dysfunction, 87% had disorders relating to the cervical spine, and 21% had cervical radiculopathy on EMG testing. Eighty-four percent (84%) of patients had sleep complaints, and 59% were diagnosed with sleep disordered breathing (19 with obstructive sleep apnea, and 10 with upper airway resistance syndrome.) For many patients, PSGs could not be carried out, despite the presence of sleep complaints, for non-medical reasons, so the prevalence of sleep disordered breathing in this population may be underestimated.

Analysis of the cervical spine X-Rays of 36 patients in this series was carried out. In those patients with a cumulative cervical spine mobility of greater than 1.25cm (n=16), migraine was found to be twice as prevalent, and chronic migraine to be five times as prevalent, compared with those patients with a cumulative cervical spine mobility less than 1.25cm (n=20).

Seventy-four percent (74%) of hypermobile patients diagnosed with headache or migraine had abnormalities of the cervical spine, symptoms of dysautonomia, and sleep disorders, while 97% had at least two of these disorders.

  Conclusions of the study

  1. Headache and migraine disorders are prevalent in hypermobile patients.
  2. Hypermobile patients with headache or migraine also have a high prevalence of sleep disordered breathing, cervical spine disorders, and symptoms of dysautonomia.
  3. Hypermobile patients with headache or migraine have comorbid conditions (sleep disordered breathing, dysautonomia, and cervical spine disorders) that need to be addressed in conjunction with other headache therapies.
  4. The prevalence of migraine and chronic migraine may be increased in patients with joint hypermobility and a cumulative cervical spine mobility of over 1.25cm

In Summary:

Patients with Hypermobility Syndrome have many related symptoms that need to be diagnosed and treated.

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