Understanding the Role of Hypermobility in Headache and Migraine
Most headache patients who come to me have episodic or chronic migraine. Most have been prescribed multiple medication regimens. I began to notice that many patients also suffered from joint hypermobility as well as headache, and had sleep problems, problems with blood pressure regulation and sometimes POTS and multiple GI and allergic symptoms, and disorders of the neck and cranio-cervical junction (where the neck meets the skull base). And if I was able to treat these other issues, patients experienced significant improvement in their headaches.
Are Headaches, Joint Hypermobility, Sleep Disorders, GI Problems, and POTS connected?
The body is complex. And I know that one symptom cannot be isolated. Appropriate treatment means treating the body as a whole. So, to properly treat patients more than one of these symptoms, I knew I needed to understand their relationship. To do this, a premedical student I was mentoring, James Barnett, and I retrospectively reviewed the charts of 49 consecutive patients with joint hypermobility syndrome (identified by having a Beighton hypermobility score greater than or equal to 5). For each patient, we measured their total cervical spine mobility, evaluated sleep complaints through the results of their polysomnograms (a sleep study), reviewed for symptoms related to pinched nerves in the neck and tabulated symptoms related to dysautonomia.
What we found fell right in line with our anecdotal observations. Seventy-three percent (73%) of these hypermobile patients had major complaints related to headache or migraine, eighty-nine percent (89%) had Disorder of Cervical Spine, eighty-three percent (83%) had sleep complaints and eighty-three percent (83%) had symptoms of dysautonomia (POTS and/or GI complaints).
Suffering just two of the disorders was in the minority. Almost half (47%) of them suffered from all four disorders. Perhaps even more fascinating, in this group of joint hypermobility syndrome patients, those with cervical spine mobility of greater than 1.25cm (n=16) experienced migraines with a prevalence more than two times, and chronic migraine more than 7 times that of those patients with a cumulative cervical spine mobility less than 1.25cm.
No Symptom Stands Alone
The results were clear. Headache and migraine disorders are prevalent in hypermobile patients. Hypermobile patients with headaches or migraines also have a high prevalence of sleep-disordered breathing, cervical spine disorders, and symptoms of dysautonomia.
Research conducted previous to this study had pointed out the presence of a headache and migraine in patients with Joint Hypermobility Syndromes as well as understand probable reasons for the associations. But, these new results have helped us learn more about the relationship between joint hypermobility, migraines, and cervical spine disorder. We now believe that the degree of cumulative cervical vertebral body translocation on flexion and extension appears to be an important predictor of migraine frequency and severity in patients with Joint Hypermobility Syndrome. Why? Since the Vertebral Arteries traverse the lateral masses of these vertebral bodies, they could be stimulated in some way to initiate the migraine cascade.
What Does This Mean For You?
You have headaches. You may also have sleep problems, joint hypermobility, and/or dysautonomia. What do you do? We know these disorders frequently occur together. Being aware of the symptoms your experiencing and proactively pointing them out to your doctor, can lead to a more comprehensive approach to treatment. While more research is needed to know whether this group of symptoms have a common cause, recognition of them at the outset will ensure that each of these disorders is addressed, which will help you improve your quality of life.
This post is based on a study by the researchers at RNI which was presented at the annual American Headache Society in Boston in June 2017. The authors of the paper are James Barnett, Vernon Rowe, John Hunter, Elizabeth Rowe, Doug Schell, Arlene O’Shea, Dorsey Paul, Mark Varona, Dana Winegarner, Kenneth VanOwen K, and Sophie Fisher.