267: Comorbid conditions in patients with migraine, cluster headache, and temporomandibular disorders

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary headache, Psychology, Assessment and Measurement of Pain/Nociception, Epidemiology

Background and Aims: Headaches are the most prevalent neurological disorders with more than 90% of the population reporting a lifetime history of headache. The International Classification of Headache Disorders (ICHD-3) describes headaches as primary, e.g. migraine (MI) and cluster headache (CH), and secondary, such as headache attributed to temporomandibular disorders (TMD).
Headaches are associated with psychological distress and impaired quality of life and with high costs for society. However, few studies seem to have investigated comorbid pain conditions in headache populations.
Thus, this study aimed to screen for comorbid pain conditions and psychological distress in people with MI, CH, and headache attributed to TMD.

Methods: The participants completed a questionnaire regarding headache and psychological distress and the Chronic Overlapping Pain Conditions Screener (COPCS), which screens for ten pain conditions: fibromyalgia (FMS), chronic lower back pain (CLBP), TMD, MI, tension-type headache, myalgic encephalitis/chronic fatigue (ME/CFS) urinary pelvic pain/bladder pain syndrome, irritable bowel syndrome (IBS), endometriosis, and vulvodynia.
For psychological comorbidity, the patient history questionnaire (PHQ-8, depression), the generalized anxiety disorder (GAD-7), and the pain catastrophizing scale (PCS) were completed.
Data were analyzed with Chi square test, ANOVA, Kruskall-Wallis test, and Mann-Whitney U-test, and are reported as n (%), mean (SD) or median (IQR).

Results: Ninety-eight participants with MI, 78 with CH, and 78 with TMD headaches participated. The scores for depression (p<0.001) and pain catastrophizing (p=0.003) were higher in MI and CH than in TMD. The median number of COPCs did not differ between groups and were 2.0 (2.0) for MI, 1.0 (3.0) for CH, and 2.0 (2.0) for TMD (NS). The most common conditions in MI were TMD (45%), ME/CSF (28%), and CLBP (27%). In CH the most common pain conditions were MI (47%), TMD (35%), and ME/CSF (30%), and in TMD finally, MI (32%), IBS (19%), and CLBP (17%).

Conclusions: This study shows that other comorbid conditions are common among people with headaches. It also shows that other craniofacial pains are the most common comorbid pains in persons with headaches. The increased levels of psychological distress in the MI and CH groups compared to TMD may be due to a longer headache duration and supports previous findings. However, the groups were not matched for age and sex, which may have influenced the results, though the higher proportion of women in the MI and TMD groups compared to CH, reflects the sex distribution in the general population.

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Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. doi: 10.1177/0333102417738202.

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Nichols VP, Ellard DR, Griffiths FE, Kamal A, Underwood M, Taylor SJC; CHESS team. The lived experience of chronic headache: a systematic review and synthesis of the qualitative literature. BMJ Open. 2017 Dec 15;7(12):e019929. doi: 10.1136/bmjopen-2017-019929.

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Presenting Author: Malin Ernberg
Submitting Author: Malin Ernberg

Senior Author: Malin Ernberg

IASP 2026 Global Year theme of Neuropathic Pain: No

• Marlon Ferreira Dias: DDS, MSc - Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), School of Dentistry, Araraquara, Brazil
• Caroline Ran: MSc, PhD - Centre for Cluster Headache, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
• Amir Ahoromazdae: MD - Furuhöjden Neurology, Täby, Sweden
• Daniela Aparecida de Godoi Gonçalves: DDS, PhD - Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), School of Dentistry, Araraquara, Brazil
• Andrea Carmine Belin: MSc, PhD - Centre for Cluster Headache, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
• Maria Lantz: MD, PhD - Department of Neurology, Danderyd Hospital, Danderyd, Sweden