03 March 2011

Extreme flexibility comes with triple migraine risk

People with severe forms of double jointedness are at greater risk for migraine headaches, a new study finds.


People with severe forms of double jointedness are at greater risk for migraine headaches, a new study finds. They also tend to have more severe and more frequent migraines.

Researchers say that the two conditions - joint hypermobility syndrome and migraines - may have causes rooted in the same problem.

People who fit the profile for having joint hypermobility have contortionist-like flexibility.

"It's a disease of collagen, basically," study author Dr Vincent Martin, a professor at the University of Cincinnati College of Medicine in the US, told Reuters Health.

Collagen too elastic

Martin's hypothesis is that if the collagen is too elastic, it leads to both flexible joints and very flexible blood vessels - problems involved in joint hypermobility syndrome and migraine, respectively.

Martin had noticed in his clinical practice that double-jointed patients seemed to suffer from migraines, too. He also drew from his own experience, having both hypermobility and migraine headaches.

Previous studies had noted the association, but Martin said his is the first to use the proper migraine diagnosis and an appropriate comparison group.

The study

Using data from interviews and written questionnaires, he and colleagues compared 28 severely double-jointed women to 232 women selected from the rolls of two primary care practices (hypermobility is more common among women).

As reported in Cephalalgia, 75% of double-jointed people also got migraines, versus 43% in the comparison group.

When taking into account the participants' age and medication use, double-jointed people had three times the risk of migraines compared to their less flexible peers.

They also had migraines on nearly twice as many days each month, and were more likely to experience migraine with aura.

Significant numbers

Although Martin wasn't surprised that migraines were more common among the ultra-flexible group, he was impressed by the numbers. "The fact that we found 75% of (hypermobility) patients had migraine was huge."

Dr Blair Grubb, who wasn't involved in the study, said he agrees that collagen is the link between the two conditions, and he added that the new findings didn't surprise him.

"It's one of those things where everybody knew it and somebody just got around to publishing it," said Grubb, a professor at the University of Toledo Medical Centre.

In the general population, nearly one out of every five women gets migraines (for men, it's about one in 16). That's less than in the current study, likely because both groups of women were selected from doctors' offices.

Health issues linked with hypermobility

Joint hypermobility is not strictly painful, nor does it require treatment. But many people diagnosed with it have "stacks" of other medical problems, Martin said, such as fibromyalgia, neck pain, sleep disorders and anxiety.

No possible genetic culprits have been identified.

Joint hypermobility syndrome may affect up to 10% of women, Martin said, but that includes people with milder cases. The severe form, Ehlers-Danlos syndrome, occurs in one out of every 5,000 people.

Because the 28 patients with the syndrome were selected from a specialty connective tissue clinic, there's a chance the results could have been skewed toward a sicker group.

Martin said he and his colleagues are testing whether or not this is the case in a follow-up study, by selecting double-jointed patients from primary care practices.

GlaxoSmithKline, a pharmaceutical company that markets over-the-counter and prescription medications used to treat migraine, helped fund this study. - (Kerry Grens/Reuters Health, March 2011)

Read more:
Headache? Listen to your body


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Dr Elliot Shevel is a South African migraine surgery pioneer and the founder and medical director of The Headache Clinic in Johannesburg, Durban and Cape Town, South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. He recently won a high level science debate in which he was able to prove that the current migraine diagnosis and classification is not based on data. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon. Follow the Headache Clinic on Twitter@HeadacheClinic.

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