Migraines Triggered by Double-Jointedness

Summary
A recent study in Cincinnati evaluated the association of joint hypermobility, or double jointedness, with migraine headache. Many earlier studies have shown a strong association between double jointedness and migraine, especially in females. But most of those studies did not follow strict criteria for diagnosis of migraine. Therefore, in the present study, a strict guideline was followed for the diagnosis of migraine. “Results indicated that the prevalence of migraine was 75 percent in joint hypermobility syndrome patients and 43 percent in controls.”

Introduction
Double jointedness is a familial disorder of the connective tissue, in which joints are hypermobile. Pain, dislocations and limb pain are common symptoms. The condition is also known as Ehlers-Danlos syndrome. Almost 85 to 90 percent of patients suffering from this are females. This disorder occurs because of faulty production of collagen in the body. Many earlier studies had shown that patients of this disease are at increased risk of developing migraine. Researchers in the present study repeated the study, but with strict guidelines for diagnosis of migraine. In addition, they also evaluated the frequency of migraine in joint hypermobility syndrome patients and the disability produced in them due to this type of headache. They also noted other disorders that are associated with joint hypermobility syndrome.

Methodology
* The study involved 28 patients of joint hypermobility syndrome who had come to a connective tissue clinic, and 232 controls, who were chosen from two primary health care centers.
* All the participants who suffered from headache in the previous one year were interviewed by headache experts to find out if they suffered from migraine. International Classification of Headache Disorders 2nd edition guidelines were used for diagnosis of headache. Those who suffered from migraine were asked about its frequency. Later, a migraine disability assessment was done.
* In addition to this, patients of joint hypermobility syndrome were asked questions about associated health problems.

Results
* The incidence of migraine in double-jointed patients was 75 percent, while it was 43 percent in the control group.
* Double-jointed participants suffered from migraine for an average of 10.5 days per month, while in the control group it was 5.6 days. Disability because of migraine was higher in patients with double jointedness.
* Other associated diseases in double-jointed patients were arthritis (54 percent), fibromyalgia (39 percent), postural orthostatic tachycardia (18 percent) and restless leg syndrome (18 percent).

Shortcomings/Next steps
The study involved patients who had come to a genetics clinic. It is obvious that only those patients who had some kind of disability had come to the genetics clinic. So this sample is probably not representative of whole group of double-jointed patients. The disability and the frequency of headache were self-reported by patients and this is subjective to bias. A daily diary analysis would help obtain more accurate information. The study did not take into account the frequency of painkiller used. Overusing medication might cause more frequent and disabling migraines.

Conclusion
This study has once again proved the high association between double jointedness and migraine headache, with a higher frequency, prevalence and disability in women. It has been postulated that changes in connective tissue in the brain probably leads to abnormality in blood vessels, which is responsible for triggering migraine headaches. Such understanding helps in knowing the mechanism of development of migraine, even in people who aren’t double jointed. Once the mechanism is clearly understood, specific therapeutic agents can be designed, to alleviate the pain of migraine. This study has also shown various other associated conditions such as fibromyalgia and sleep disorders. Therefore, individuals diagnosed with these conditions may need to rule out the presence of double jointedness.

For More Information:
Joint Hypermobility Syndrome: A Common Clinical Disorder Associated with Migraine in Women
Cephalalgia, January 2011
By Elise M Bendik; Brad T Tinkle; University of Cincinnati, Ohio

*FYI Living Lab Reports Are Summaries of the Original Research.


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