BMC neurology · 2026
Hormonal, metabolic, and stress-related clinical differences between episodic and chronic migraine: insights for diagnostic and therapeutic approaches.
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Gozubatik-Celik Rabia Gokcen, Uludüz Ezgi, Eyüboğlu Sevim, İskender Mustafa, Sungur Mehmet Ali, Özge Aynur, Uludüz Derya
Аннотация
BACKGROUND: Migraine, a common neurological disorder, is categorized into episodic (EM) and chronic (CM) forms. Understanding their hormonal and metabolic differences can enhance insights into migraine pathophysiology and guide clinical approaches.
OBJECTIVE: To explore hormonal and metabolic imbalances in EM and CM patients and identify key factors contributing to migraine chronicity.
METHODS: This retrospective, cross-sectional study included 500 patients with migraine (318 EM and 182 CM). Data were retrospectively extracted from pre-existing clinical records, structured intake forms, physician examination notes, questionnaire-based assessments, and available laboratory results to evaluate demographic, clinical, metabolic, stress-related, mental health-related, and comorbidity variables.
RESULTS: CM patients were older (46.28 vs. 43.13 years, p = 0.002) and had more frequent severe attacks (15 vs. 8/month) and mild attacks (12 vs. 6/month) (p < 0.001). CM patients exhibited higher rates of anaemia (34.9% vs. 25.7%, p = 0.035), asthma (12.8% vs. 7.3%, p = 0.046), and sleep apnea (4.7% vs. 1.3%, p = 0.034). Fibromyalgia-related symptoms were common in both groups (82.1% in CM vs. 78.2% in EM), while the number of fibromyalgia tender points was higher in CM than in EM patients (median 8 vs. 6). Ferritin levels were lower in CM but not significantly so (p = 0.139). Suicidal thoughts and feelings of helplessness were more common in CM (p = 0.016, p = 0.002). CM patients used Botox more often but with lower efficacy and engaged in more cognitive behavioural therapy (p = 0.002).
CONCLUSION: CM was associated with more severe symptoms, higher comorbidity burden, more widespread pain features, and distinct metabolic and stress-related profiles compared with EM. These findings support the early recognition of clinical and comorbid factors associated with the chronic migraine phenotype.
OBJECTIVE: To explore hormonal and metabolic imbalances in EM and CM patients and identify key factors contributing to migraine chronicity.
METHODS: This retrospective, cross-sectional study included 500 patients with migraine (318 EM and 182 CM). Data were retrospectively extracted from pre-existing clinical records, structured intake forms, physician examination notes, questionnaire-based assessments, and available laboratory results to evaluate demographic, clinical, metabolic, stress-related, mental health-related, and comorbidity variables.
RESULTS: CM patients were older (46.28 vs. 43.13 years, p = 0.002) and had more frequent severe attacks (15 vs. 8/month) and mild attacks (12 vs. 6/month) (p < 0.001). CM patients exhibited higher rates of anaemia (34.9% vs. 25.7%, p = 0.035), asthma (12.8% vs. 7.3%, p = 0.046), and sleep apnea (4.7% vs. 1.3%, p = 0.034). Fibromyalgia-related symptoms were common in both groups (82.1% in CM vs. 78.2% in EM), while the number of fibromyalgia tender points was higher in CM than in EM patients (median 8 vs. 6). Ferritin levels were lower in CM but not significantly so (p = 0.139). Suicidal thoughts and feelings of helplessness were more common in CM (p = 0.016, p = 0.002). CM patients used Botox more often but with lower efficacy and engaged in more cognitive behavioural therapy (p = 0.002).
CONCLUSION: CM was associated with more severe symptoms, higher comorbidity burden, more widespread pain features, and distinct metabolic and stress-related profiles compared with EM. These findings support the early recognition of clinical and comorbid factors associated with the chronic migraine phenotype.