title: Chronic migraine and chronic tension-type headache are associated with concomitant low back pain: results of the German Headache Consortium study.
abstract: The objective of this study was to evaluate the association between low and frequent low back pain and chronic migraine (CM) and chronic tension-type headache (CTTH) in a large, German population-based sample. Headaches were diagnosed according to International Classification of Headache Disorders-2 criteria and categorized according to frequency (episodic 1-14 days/month or chronic ≤15 days/month) and headache type (migraine or TTH). We defined frequent low back pain as self-reported low back pain on ≥15 days/month. We calculated odds ratios and 95% confidence intervals (CI) using logistic regression analyses, adjusting for sociodemographic covariates. There were 5605 respondents who reported headache in the previous year, of whom 255 (4.5%) had Chronic Headache. Migraine was diagnosed in 2933 respondents, of whom 182 (6.2%) had CM. TTH was diagnosed in 1253 respondents, of whom 50 (4.0%) had CTTH. Among 9944 respondents, 6030 reported low back pain, of whom 1267 (21.0%) reported frequent low back pain. In adjusted models, the odds of having frequent low back pain were between 2.1 (95% CI 1.7-2.6) and 2.7 (95% CI 2.3-3.2) times higher in all episodic headache subtypes when compared to No Headache. The odds of having frequent low back pain were between 13.7 (95% CI 7.4-25.3) and 18.3 (95% CI 11.9-28.0) times higher in all chronic headache subtypes when compared to No Headache. Low and frequent low back pain was associated with CM and CTTH. Multiple explanations may contribute to the association of headache and back pain, including the notion that the neurobiology of chronic headache, independent of primary headache type, not only involves the trigeminal pain pathway, but is also a part of abnormal general pain processing.
authors: Department of Neurology, University Hospital of Essen, Essen, Germany Department of Neurology, St. Joseph Hospital, Ruhr-University of Bochum, Bochum, Germany Allergan, Inc, Irvine, CA, USA Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany.
authors: Min-Suk
authors: MS
authors: Yoon
authors: Aubrey
authors: A
authors: Manack
authors: Sara
authors: S
authors: Schramm
authors: Guenther
authors: G
authors: Fritsche
authors: Mark
authors: M
authors: Obermann
authors: Hans-Christoph
authors: HC
authors: Diener
authors: Susanne
authors: S
authors: Moebus
authors: Zaza
authors: Z
authors: Katsarava
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D000700:Analgesics / Q000627:therapeutic use; D015897:Comorbidity; D004363:Drug Utilization / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D005858:Germany / Q000453:epidemiology; D020773:Headache Disorders / Q000453:epidemiology*; D006801:Humans; D007407:Interviews as Topic; D017116:Low Back Pain / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology* / Q000503:physiopathology; D059225:Nociception / Q000502:physiology; D012907:Smoking / Q000453:epidemiology; D018781:Tension-Type Headache / Q000175:diagnosis / Q000453:epidemiology*; D014276:Trigeminal Nerve / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000700:Analgesics
references: Aaron LA, Herrell R, Ashton S, Belcourt M, Schmaling K, Goldberg J, Buchwald D. Comorbid clinical conditions in chronic fatigue: a co-twin control study. J Gen Intern Med. 2001;16:24-31.
references: Apkarian AV, Sosa Y, Sonty S, Levy RM, Harden RN, Parrish TB, Gitelman DR. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci. 2004;24:10410-10415.
references: Ashina S, Lipton RB, Bigal ME. Treatment of comorbidities of chronic daily headache. Curr Treat Options Neurol. 2008;10:36-43.
references: Aurora SK. Spectrum of illness: understanding biological patterns and relationships in chronic migraine. Neurology. 2009;72:S8-S13.
references: Aurora SK, Kulthia A, Barrodale PM. Mechanism of chronic migraine. Curr Pain Headache Rep. 2011;15:57-63.
references: Ayzenberg I, Katsarava Z, Sborowski A, Chernysh M, Osipova V, Tabeeva G, Yakhno N, Steiner T. The prevalence of primary headache disorders in Russia: a countrywide survey. Cephalalgia. 2012;32:373-381.
references: Bahra A, Matharu MS, Buchel C, Frackowiak RS, Goadsby PJ. Brainstem activation specific to migraine headache. Lancet. 2001;357:1016-1017.
references: Bigal ME, Lipton RB. Migraine chronification. Curr Neurol Neurosci Rep. 2011;11:139-148.
references: Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache. 2008;48:1157-1168.
references: Blumenfeld A, Varon S, Wilcox TK, Buse D, Kawata AK, Manack A, Goadsby PJ, Lipton RB. Disability, HRQoL and resource use among chronic and episodic migraineurs: results from the International Burden of Migraine Study (IBMS). Cephalalgia. 2011;31:301-315.
references: Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10:287-333.
references: Breslau N, Davis GC, Andreski P. Migraine, psychiatric disorders, and suicide attempts: an epidemiologic study of young adults. Psychiatry Res. 1991;37:11-23.
references: Breslau N, Schultz LR, Stewart WF, Lipton RB, Lucia VC, Welch KM. Headache and major depression: is the association specific to migraine? Neurology. 2000;54:308-313.
references: Buse DC, Manack A, Serrano D, Turkel C, Lipton RB. Sociodemographic and comorbidity profiles of chronic migraine and episodic migraine sufferers. J Neurol Neurosurg Psychiatry. 2010;81:428-432.
references: Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? JAMA. 2010;303:1295-1302.
references: DaSilva AF, Granziera C, Snyder J, Hadjikhani N. Thickening in the somatosensory cortex of patients with migraine. Neurology. 2007;69:1990-1995.
references: DaSilva AF, Granziera C, Tuch DS, Snyder J, Vincent M, Hadjikhani N. Interictal alterations of the trigeminal somatosensory pathway and periaqueductal gray matter in migraine. Neuroreport. 2007;18:301-305.
references: de Tommaso M, Federici A, Serpino C, Vecchio E, Franco G, Sardaro M, Delussi M, Livrea P. Clinical features of headache patients with fibromyalgia comorbidity. J Headache Pain. 2011;12:629-638.
references: de Tommaso M, Libro G, Guido M, Sciruicchio V, Losito L, Puca F. Heat pain thresholds and cerebral event-related potentials following painful CO2 laser stimulation in chronic tension-type headache. PAIN®. 2003;104:111-119.
references: de Tommaso M, Losito L, Difruscolo O, Libro G, Guido M, Livrea P. Changes in cortical processing of pain in chronic migraine. Headache. 2005;45:1208-1218.
references: de Tommaso M, Sardaro M, Serpino C, Costantini F, Vecchio E, Prudenzano MP, Lamberti P, Livrea P. Fibromyalgia comorbidity in primary headaches. Cephalalgia. 2009;29:453-464.
references: Draganski B, Moser T, Lummel N, Ganssbauer S, Bogdahn U, Haas F, May A. Decrease of thalamic gray matter following limb amputation. Neuroimage. 2006;31:951-957.
references: Elliott AM, Smith BH, Hannaford PC, Smith WC, Chambers WA. The course of chronic pain in the community: results of a 4-year follow-up study. PAIN®. 2002;99:299-307.
references: Evans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KR, Nemeroff CB, Bremner JD, Carney RM, Coyne JC, Delong MR, Frasure-Smith N, Glassman AH, Gold PW, Grant I, Gwyther L, Ironson G, Johnson RL, Kanner AM, Katon WJ, Kaufmann PG, Keefe FJ, Ketter T, Laughren TP, Leserman J, Lyketsos CG, McDonald WM, McEwen BS, Miller AH, Musselman D, O’Connor C, Petitto JM, Pollock BG, Robinson RG, Roose SP, Rowland J, Sheline Y, Sheps DS, Simon G, Spiegel D, Stunkard A, Sunderland T, Tibbits P Jr, Valvo WJ. Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry. 2005;58:175-189.
references: Fernández-de-las-Peñas C, Hernández-Barrera V, Alonso-Blanco C, Palacios-Ceña D, Carrasco-Garrido P, Jiménez-Sánchez S, Jiménez-García R. Prevalence of neck and low back pain in community-dwelling adults in Spain: a population-based national study. Spine (Phila Pa 1976). 2011;36:E213-E219.
references: Fritsche G, Hueppe M, Kukava M, Dzagnidze A, Schuerks M, Yoon MS, Diener HC, Katsarava Z. Validation of a German language questionnaire for screening for migraine, tension-type headache, and trigeminal autonomic cephalgias. Headache. 2007;47:546-551.
references: Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain. Orthop Clin North Am. 1991;22:263-271.
references: Gureje O, Von KM, Simon GE, Gater R. Persistent pain and well-being: a World Health Organization study in primary care. JAMA. 1998;280:147-151.
references: Hagen EM, Svensen E, Eriksen HR, Ihlebaek CM, Ursin H. Comorbid subjective health complaints in low back pain. Spine (Phila Pa 1976). 2006;31:1491-1495.
references: Hagen K, Einarsen C, Zwart JA, Svebak S, Bovim G. The co-occurrence of headache and musculoskeletal symptoms amongst 51,050 adults in Norway. Eur J Neurol. 2002;9:527-533.
references: Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders, 2nd ed. Cephalalgia. 2004;24:9-160.
references: Hestbaek L, Korsholm L, Leboeuf-Yde C, Kyvik KO. Does socioeconomic status in adolescence predict low back pain in adulthood? A repeated cross-sectional study of 4771 Danish adolescents. Eur Spine J. 2008;17:1727-1734.
references: Hestbaek L, Leboeuf-Yde C, Kyvik KO. Is comorbidity in adolescence a predictor for adult low back pain? A prospective study of a young population. BMC Musculoskelet Disord. 2006;7:29.
references: Hestbaek L, Leboeuf-Yde C, Kyvik KO, Vach W, Russell MB, Skadhauge L, Svendsen A, Manniche C. Comorbidity with low back pain: a cross-sectional population-based survey of 12- to 22-year-olds. Spine (Phila Pa 1976). 2004;29:1483-1491.
references: Hestbaek L, Leboeuf-Yde C, Manniche C. Is low back pain part of a general health pattern or is it a separate and distinctive entity? A critical literature review of comorbidity with low back pain. J Manipulative Physiol Ther. 2003;26:243-252.
references: Holle D, Gaul C, Zillessen S, Naegel S, Krebs S, Diener HC, Kaube H, Katsarava Z, Obermann M. Lateralized central facilitation of trigeminal nociception in cluster headache. Neurology. 2012;78:985-992.
references: Holroyd KA, Labus JS, Carlson B. Moderation and mediation in the psychological and drug treatment of chronic tension-type headache: the role of disorder severity and psychiatric comorbidity. PAIN®. 2009;143:213-222.
references: Juang KD, Wang SJ, Fuh JL, Lu SR, Su TP. Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes. Headache. 2000;40:818-823.
references: Katsarava Z, Dzagnidze A, Kukava M, Mirvelashvili E, Djibuti M, Janelidze M, Jensen R, Stovner LJ, Steiner TJ. Primary headache disorders in the Republic of Georgia: prevalence and risk factors. Neurology. 2009;73:1796-1803.
references: Katsarava Z, Schneeweiss S, Kurth T, Kroener U, Fritsche G, Eikermann A, Diener HC, Limmroth V. Incidence and predictors for chronicity of headache in patients with episodic migraine. Neurology. 2004;62:788-790.
references: Kim JH, Suh SI, Seol HY, Oh K, Seo WK, Yu SW, Park KW, Koh SB. Regional grey matter changes in patients with migraine: a voxel-based morphometry study. Cephalalgia. 2008;28:598-604.
references: Kuchinad A, Schweinhardt P, Seminowicz DA, Wood PB, Chizh BA, Bushnell MC. Accelerated brain gray matter loss in fibromyalgia patients: premature aging of the brain? J Neurosci. 2007;27:4004-4007.
references: Lantéri-Minet M, Valade D, Géraud G, Chautard MH, Lucas C. Migraine and probable migraine—results of FRAMIG 3, a French nationwide survey carried out according to the 2004 IHS classification. Cephalalgia. 2005;25:1146-1158.
references: Lepine JP, Briley M. The epidemiology of pain in depression. Hum Psychopharmacol. 2004;19:S3-S7.
references: Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001;41:646-657.
references: Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine (Phila Pa 1976). 2004;29:79-86.
references: May A. New insights into headache: an update on functional and structural imaging findings. Nat Rev Neurol. 2009;5:199-209.
references: Merikangas KR, Angst J, Isler H. Migraine and psychopathology. Results of the Zurich cohort study of young adults. Arch Gen Psychiatry. 1990;47:849-853.
references: Moulton EA, Burstein R, Tully S, Hargreaves R, Becerra L, Borsook D. Interictal dysfunction of a brainstem descending modulatory center in migraine patients. PLoS One. 2008;3:e3799.
references: Natoli J, Manack A, Dean B, Butler Q, Turkel C, Stovner L, Lipton R. Global prevalence of chronic migraine: a systematic review. Cephalalgia. 2010;30:599-609.
references: Obermann M, Nebel K, Schumann C, Holle D, Gizewski ER, Maschke M, Goadsby PJ, Diener HC, Katsarava Z. Gray matter changes related to chronic posttraumatic headache. Neurology. 2009;73:978-983.
references: Obermann M, Yoon MS, Ese D, Maschke M, Kaube H, Diener HC, Katsarava Z. Impaired trigeminal nociceptive processing in patients with trigeminal neuralgia. Neurology. 2007;69:835-841.
references: Peres MF, Young WB, Kaup AO, Zukerman E, Silberstein SD. Fibromyalgia is common in patients with transformed migraine. Neurology. 2001;57:1326-1328.
references: Peres MF, Zukerman E, Young WB, Silberstein SD. Fatigue in chronic migraine patients. Cephalalgia. 2002;22:720-724.
references: Plesh O, Adams SH, Gansky SA. Self-reported comorbid pains in severe headaches or migraines in a US national sample. Headache. 2012;52:946-956.
references: Plesh O, Noonan C, Buchwald DS, Goldberg J, Afari N. Temporomandibular disorder-type pain and migraine headache in women: a preliminary twin study. J Orofac Pain. 2012;26:91-98.
references: Ratcliffe GE, Enns MW, Jacobi F, Belik SL, Sareen J. The relationship between migraine and mental disorders in a population-based sample. Gen Hosp Psychiatry. 2009;31:14-19.
references: Rocca MA, Ceccarelli A, Falini A, Colombo B, Tortorella P, Bernasconi L, Comi G, Scotti G, Filippi M. Brain gray matter changes in migraine patients with T2-visible lesions: a 3-T MRI study. Stroke. 2006;37:1765-1770.
references: Scher AI, Stewart WF, Buse D, Krantz DS, Lipton RB. Major life changes before and after the onset of chronic daily headache: a population-based study. Cephalalgia. 2008;28:868-876.
references: Schmidt-Wilcke T, Leinisch E, Ganssbauer S, Draganski B, Bogdahn U, Altmeppen J, May A. Affective components and intensity of pain correlate with structural differences in gray matter in chronic back pain patients. PAIN®. 2006;125:89-97.
references: Schmidt-Wilcke T, Leinisch E, Straube A, Kampfe N, Draganski B, Diener HC, Bogdahn U, May A. Gray matter decrease in patients with chronic tension type headache. Neurology. 2005;65:1483-1486.
references: Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171:135-154.
references: Steiner TJ, Scher AI, Stewart WF, Kolodner K, Liberman J, Lipton RB. The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity. Cephalalgia. 2003;23:519-527.
references: Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors. JAMA. 1992;267:64-69.
references: Stewart WF, Wood GC, Manack A, Varon SF, Buse DC, Lipton RB. Employment and work impact of chronic migraine and episodic migraine. J Occup Environ Med. 2010;52:8-14.
references: Stovner LJ, Zwart JA, Hagen K, Terwindt GM, Pascual J. Epidemiology of headache in Europe. Eur J Neurol. 2006;13:333-345.
references: Tietjen GE, Brandes JL, Peterlin BL, Eloff A, Dafer RM, Stein MR, Drexler E, Martin VT, Hutchinson S, Aurora SK, Recober A, Herial NA, Utley C, White L, Khuder SA. Childhood maltreatment and migraine (part III). Association with comorbid pain conditions. Headache. 2010;50:42-51.
references: Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, Borges GL, Bromet EJ, Demytteneare K, de Girolamo G, de Graaf R, Gureje O, Lepine JP, Haro JM, Levinson D, Oakley Browne MA, Posada-Villa J, Seedat S, Watanabe M. Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008;9:883-891.
references: Valfre W, Rainero I, Bergui M, Pinessi L. Voxel-based morphometry reveals gray matter abnormalities in migraine. Headache. 2008;48:109-117.
references: Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord. 2000;13:205-217.
references: Weiller C, May A, Limmroth V, Juptner M, Kaube H, Schayck RV, Coenen HH, Diener HC. Brain stem activation in spontaneous human migraine attacks. Nat Med. 1995;1:658-660.
references: Winter AC, Berger K, Buring JE, Kurth T. Associations of socioeconomic status with migraine and non-migraine headache. Cephalalgia. 2012;32:159-170.
references: Wrigley PJ, Gustin SM, Macey PM, Nash PG, Gandevia SC, Macefield VG, Siddall PJ, Henderson LA. Anatomical changes in human motor cortex and motor pathways following complete thoracic spinal cord injury. Cereb Cortex. 2009;19:224-232.
references: Yoon MS, Katsarava Z, Obermann M, Fritsche G, Oezyurt M, Kaesewinkel K, Katsarova A, Santowski I, Diener H, Moebus S. Prevalence of primary headaches in Germany: results of the German headache consortium study. J Headache Pain. 2012;13:215-223.
references: Yoon MS, Mueller D, Hansen N, Poitz F, Slomke M, Dommes P, Diener HC, Katsarava Z, Obermann M. Prevalence of facial pain in migraine: a population-based study. Cephalalgia. 2010;30:92-96.
references: Yoon MS, Obermann M, Fritsche G, Slomke M, Dommes P, Schilf C, Diener HC, Katsarava Z. Population-based validation of a German-language self-administered headache questionnaire. Cephalalgia. 2008;28:605-608.
references: Zwart JA, Dyb G, Hagen K, Ødegård KJ, Dahl AA, Bovim G, Stovner LJ. Depression and anxiety disorders associated with headache frequency. The Nord-Trondelag health study. Eur J Neurol. 2003;10:147-152.
references: Zwart JA, Dyb G, Hagen K, Svebak S, Holmen J. Analgesic use: a predictor of chronic pain and medication overuse headache: the head–HUNT study. Neurology. 2003;61:160-164.
references: Zwart JA, Dyb G, Hagen K, Svebak S, Stovner LJ, Holmen J. Analgesic overuse among subjects with headache, neck, and low-back pain. Neurology. 2004;62:1540-1544.