Comorbidity Rates in a Large Cohort of Patients with Migraine: A Real-world Data Analysis
Ariel Israel1, Shlomo Vinker1, Danna-Li Davidovici2, Matanya Tirosh3, Itay Forschner4, Erel Domany4, Alla Shifrin5
1Leumit Health Services, 2Pfizer Pharmaceuticals Israel LTD, 3Pfizer, 4Rambam Healthcare Campus, 5Rambam Medical Center
Objective:

To characterize comorbidity rates among migraine patients and compare them with those in non-migraine populations among adult members of Leumit Healthcare Services (LHS), a national healthcare provider.

Background:

Migraine is a prevalent primary headache disorder often associated with additional medical conditions. However, existing data regarding the prevalence of these comorbidities among migraine patients remain inconclusive.

Design/Methods:
We conducted a retrospective descriptive study utilizing electronic health records from LHS to assess migraine comorbidities among adults from 2017 to 2022. The migraine population was compared to a control group of the same age, gender, ethnic group, regional district, and socioeconomic status (SES) in a 1:1 ratio.
Results:

Based on our database, migraine patients exhibited a higher prevalence of smoking (OR=1.14,P=0.0004) but had a slightly lower proportion of obese patients (defined as BMI above 30) compared to the control group (OR=0.94,P<0.001). Hypertension was more prevalent among patients with migraine, while the rate of diabetes mellitus was lower (OR=0.86,P<0.001). We observed higher incidences of transient ischemic attack (TIA) and cerebrovascular accidents (CVA) in the migraine group, with no significant increase in myocardial infarction (MI) events when compared to the control group. Furthermore, the migraine group showed significantly elevated rates of vertigo/dizziness (OR=2.05,P<0.001), backache (OR=2.26,P<0.001), depression (OR=1.71,P<0.001), and fibromyalgia (OR=2.33,P<0.001). Importantly, we found significant associations with chronic inflammatory conditions such as ankylosing spondylitis (OR=1.94,P<0.001), systemic lupus erythematosus (SLE) (OR=1.74,P<0.001), inflammatory bowel disease (IBD) (OR=1.45,P<0.001), psoriasis (OR=1.25,P<0.001), and psoriatic arthritis (OR=1.67,P<0.001).

Conclusions:

Individuals with migraine experience a higher incidence of CVA and TIA, despite having a lower body mass index (BMI) and reduced rates of conventional cardiovascular risk factors and diabetes mellitus when compared to a matched control population. Additionally, individuals with migraine exhibit higher rates of concurrent inflammatory conditions, suggesting potential inflammatory mechanisms and/or deficient pain regulation/ suppression of the central nervous system, in the development of migraines.

10.1212/WNL.0000000000206400