Make Headache Screening Part of Fibromyalgia Work-Up

Article excerpt

RANCHO MIRAGE, CALIF. -- Headaches are frequently part of the pathology of fibromyalgia.

In a recent study of 57 patients with fibromyalgia, 75% had a history of chronic headaches, and of those patients, 86% said that the headaches had a severe or substantial impact on their lives, Dr. Dawn A. Marcus reported at a meeting sponsored by the Diamond Headache Clinic.

These findings suggest that headache screening and treatment should be part of the work-up for fibromyalgia, said Dr. Marcus, director of the headache clinic at the University of Pittsburgh Medical Center.

In the study, overall measures of pain, pain-related disability, and psychological distress were similar between patients with and without headache, suggesting that headaches may be part of the neurologic dysregulation that characterizes fibromyalgia, rather than a comorbid condition, she said.

The study included 56 women and 1 man seeking treatment for fibromyalgia at the university's pain clinic. Their assessment included a neurologic examination and a fibromyalgia tender-point examination. Headaches were diagnosed according to International Headache Society criteria.

The patients also completed a variety of self-report measures to assess their levels of pain, disability, and psychological distress.

Headaches were reported by 43 of the patients. (See table.) Migraine was the most common headache type, followed by tension-type headache and headaches resulting from analgesic overuse. Posttraumatic headache was the least common type, diagnosed in only two patients, a surprising finding given that fibromyalgia frequently occurs after an injury, Dr. Marcus said.

Among the questionnaires the patients completed was the 6-item Headache Impact Test (HIT-6), which uses a scale of 36-78 to measure the disruption in one's life caused by headaches. …