Kumar Hemant, Dhamija Kamakshi, Duggal Ashish, Khwaja Geeta Anjum, Roshan Sujata
Department of Neurology, GIPMER, Delhi, India.
Department of Neurology, VMMC and Safdarjung Hospital, Delhi, India.
J Neurosci Rural Pract. 2023 Jul-Sep;14(3):424-431. doi: 10.25259/JNRP_63_2022. Epub 2023 Apr 20.
Fatigue is a common symptom occurring in a variety of disorders. Chronic fatigue syndrome (CFS) is characterized by debilitating fatigue as the core symptom. The risk of CFS is nearly 1.5 times higher in migraine while headaches have been reported in 59% of cases with CFS. However, details of its occurrence and severity remain largely unexplored. The primary objective of our study was to determine the occurrence and severity of fatigue and CFS in patients with episodic and chronic migraine. The secondary objectives were to define their relationship with other common comorbidities.
60 migraine patients (30 each, episodic [EM] and chronic migraine [CM]) were recruited from Neurology Outpatient Department, GIPMER a tertiary referral center in New Delhi, India. Patients' headache severity was analyzed using the Headache impact test-6 (HIT-6) score while fatigue and other migraine accompaniments were assessed using Fatigue severity scale (FSS), Chalder fatigue scale, CDC diagnostic criteria for CFS, American College of Rheumatology Diagnostic Criteria for fibromyalgia, Hamilton Depression Scale, the Generalized Anxiety Disorder 7-Item Scale, and Epworth sleepiness Scale (ESS). Comparative analysis was further done among migraine patients with and without fatigue and CFS.
The mean HIT-6 score was significantly higher in CM versus EM. The CM group had a higher mean FSS score (47.87 vs. 37.3 in EM; = 0.004), a percentage of patients with severe fatigue (60% vs. 20% in EM; = 0.004), and a higher percentage of patients with pathological fatigue (83.3% vs. 63.3% in EM; = 0.04). Around 23.33% of CM patients fulfilled the criteria of CFS. Fatigue correlated positively with severity, frequency, attack duration and chronicity of the migraine episodes, along with depression, anxiety, and excessive daytime sleepiness.
Fatigue and related comorbid disorders are significantly more common in CM than in EM, expanding the morbidity of the condition and underscores the need to address these accompanying symptoms for devising a holistic treatment plan.
疲劳是多种疾病中常见的症状。慢性疲劳综合征（CFS）以使人衰弱的疲劳为核心症状。偏头痛患者患CFS的风险几乎高出1.5倍，而59%的CFS患者有头痛症状。然而，其发生情况和严重程度的细节在很大程度上仍未得到充分研究。我们研究的主要目的是确定发作性和慢性偏头痛患者中疲劳和CFS的发生情况及严重程度。次要目的是明确它们与其他常见合并症的关系。
从印度新德里的三级转诊中心GIPMER的神经科门诊招募了60名偏头痛患者（发作性偏头痛[EM]和慢性偏头痛[CM]各30名）。使用头痛影响测试-6（HIT-6）评分分析患者的头痛严重程度，同时使用疲劳严重程度量表（FSS）、查尔德疲劳量表、CFS的疾病控制与预防中心诊断标准、纤维肌痛的美国风湿病学会诊断标准、汉密尔顿抑郁量表、广泛性焦虑障碍7项量表和爱泼华嗜睡量表（ESS）评估疲劳及其他偏头痛伴随症状。对有和没有疲劳及CFS的偏头痛患者进行进一步的对比分析。
CM患者的平均HIT-6评分显著高于EM患者。CM组的平均FSS评分更高（EM组为37.3，CM组为47.87；P = 0.004），严重疲劳患者的百分比更高（EM组为20%，CM组为60%；P = 0.004），病理性疲劳患者的百分比也更高（EM组为63.3%，CM组为83.3%；P = 0.04）。约23.33%的CM患者符合CFS标准。疲劳与偏头痛发作的严重程度、频率、发作持续时间和慢性程度呈正相关，还与抑郁、焦虑和日间过度嗜睡相关。
CM患者中疲劳及相关合并症明显比EM患者更常见，这扩大了该病的发病率，并强调在制定整体治疗方案时需要处理这些伴随症状。
