Migraine Headaches in Patients with Upper Extremity Compressive Neuropathy.

BACKGROUND

Upper extremity nerve compression syndromes and migraines caused by nerve entrapment have many similarities, including patient presentation, anatomical findings, and treatment by surgical decompression of affected nerves. Parallels between the two conditions point toward the possibility of shared predisposition. The aim of this study was to evaluate the relationship between migraine and upper extremity nerve compression.

METHODS

Nine thousand five hundred fifty-eight patients who underwent nerve decompression surgery of the upper extremity (median, ulnar, and radial nerves and thoracic outlet syndrome) as identified by CPT and International Classification of Diseases codes were included in the analysis. International Classification of Diseases codes for migraine and comorbidities included as part of the Elixhauser Comorbidity Index were identified. Bivariate and multivariable logistic regression was performed.

RESULTS

Median nerve decompression (OR, 1.3; 95 percent CI, 1.0 to 1.8; p = 0.046) and multiple nerve decompressions (OR, 1.7; 95 percent CI, 1.2 to 2.5; p = 0.008) were independently associated with higher rates of migraine compared to ulnar nerve decompression and thoracic outlet syndrome. Older age and male sex had a negative association with migraine. History of psychiatric disease, rheumatoid arthritis/collagen vascular diseases, hypothyroidism, hypertension, and chronic pulmonary disease were independently associated with migraine headache.

CONCLUSIONS

Patients who undergo median and multiple nerve decompression are more likely to experience migraine headache. It is important to recognize this overlap and provide comprehensive patient screening for both conditions. This shared predisposition and better understanding of a common disease mechanism and genetics may provide greater insight into the pathogenesis and therefore treatment of these clinical problems.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.