Beyond Headache: Non-cephalic Pain, Fatigue, and Post-Traumatic Stress Symptoms as Longitudinal Predictors of Chronic Migraine Outcomes

Objective Chronic migraine is a condition marked by highly frequent, intense, and disabling headaches. However, less commonly examined symptoms, such as persistent fatigue, widespread non-cephalic pain, and post-traumatic stress disorder, may also play a key role in migraine-relevant clinical outcomes. Methods The current study utilized retrospective clinical registry data from 704 treatment-seeking patients with chronic migraine to examine longitudinal trajectories of pain intensity and pain-related life interference using linear growth modeling. Results High levels of co-occurring non-cephalic pain (71.9% of patients) were noted in this sample. Patients endorsing more widespread pain reported higher average levels of pain intensity over time (β = 0.189 [0.103, 0.275], p < 0.001) and less improvement in pain interference over time (β = 0.328 [0.131, 0.525], p = 0.001). Additional findings included greater reductions in pain interference among patients with higher baseline levels of pain intensity (β = -0.185 [-0.351, -0.020], p = 0.028) and fatigue (β = -0.280 [-0.493, -0.067], p = 0.010) and non-significant associations between post-traumatic stress symptoms and pain intensity and pain interference in all models. Conclusions The current findings suggest that clinical factors sometimes overlooked in headache research, such as co-occurring non-cephalic pain and fatigue, may contribute to trajectories of treatment response and psychosocial function in chronic migraine. Future research may benefit from examining these factors in headache-specific treatment settings and in the context of examining the effects of multidisciplinary care on patients with complex symptom presentations.