Original Research ARTICLE
Migraine in gulf war illness and chronic fatigue syndrome: prevalence, potential mechanisms, and evaluation
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Georgetown University, Washington, DC, USA
Objective: To assess the prevalence of headache subtypes in Gulf War Illness (GWI) and Chronic Fatigue Syndrome (CFS) compared to controls.
Background: Approximately, 25% of the military personnel who served in the 1990–1991 Persian Gulf War have developed GWI. Symptoms of GWI and CFS have considerable overlap, including headache complaints. Migraines are reported in CFS. The type and prevalence of headaches in GWI have not been adequately assessed.
Methods: 50 GWI, 39 CFS and 45 controls had structured headache evaluations based on the 2004 International Headache Society criteria. All subjects had history and physical examinations, fatigue and symptom related questionnaires, measurements of systemic hyperalgesia (dolorimetry), and assessments for exclusionary conditions.
Results: Migraines were detected in 64% of GWI (odds ratio = 11.6 [4.1–32.5]) (mean [±95% CI]) and 82% of CFS subjects (odds ratio = 22.5 [7.8–64.8]) compared to only 13% of controls. There was a predominance of females in the CFS compared to GWI and controls. However, migraine status was independent of gender in GWI and CFS groups (x2 = 2.7; P = 0.101). Measures of fatigue, pain, and other ancillary criteria were comparable between GWI and CFS subjects with and without headache.
Conclusion: The high prevalence of migraine in CFS was confirmed and extended to GWI subjects. GWI and CFS may share dysfunctional central pathophysiological pathways that contribute to migraine and subjective symptoms. The high migraine prevalence warrants the inclusion of a structured headache evaluation in GWI and CFS subjects, and treatment when present.
Keywords: migraine, gulf war illness, chronic fatigue syndrome, fibromyalgia, central sensitization, chronic pain, fatigue, neurolimbic pathway
Citation: Rayhan RU, Ravindran MK and Baraniuk JN (2013) Migraine in gulf war illness and chronic fatigue syndrome: prevalence, potential mechanisms, and evaluation. Front. Physiol. 4:181. doi: 10.3389/fphys.2013.00181
Received: 26 March 2013; Accepted: 25 June 2013;
Published online: 24 July 2013.
Edited by:Julian M. Stewart, New York Medical College, USA
Reviewed by:Kathleen S. Curtis, Oklahoma State University, USA
Abdu Adem, United Arab Emirates University, UAE
Copyright © 2013 Rayhan, Ravindran and Baraniuk. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and subject to any copyright notices concerning any third-party graphics etc.
*Correspondence: Rakib U. Rayhan, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Room 3004F, 3rd Floor PHC Building, Georgetown University, 3800 Reservoir Road, NW, Washington, DC 20007-2197, USA e-mail: email@example.com