Teens with hypermobile EDS twice as likely to have chronic headaches
Better recognition of HSD/hEDS may aid early diagnosis, better treatments
Adolescents with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSD) are twice as likely to have active migraine than those without the diseases, according to a recent study in Israel.
Migraine is a type of headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head.
“Better characterization of pain phenotypes and systemic manifestations of patients with HSD/hEDS may promote early diagnosis and targeted treatment strategies,” the researchers wrote in ”Hypermobility spectrum disorders and active migraine in Israeli adolescents: A nationwide study,” which was published in Headache – The Journal of Head and Face Pain.
EDS refers to a group of genetic disorders that affect the connective tissues, which provide structure to joints, skin, blood vessels, and other tissues and organs. It’s typically marked by hypermobile joints, fragile skin, and chronic pain. The most common disease type is hEDS, which overlaps clinically with HSD.
Although several studies examined a possible association between migraine and HSD/hEDS, the results were inconsistent and the studies were limited to adults.
Link between migraine and HSD/hEDS
Researchers in Israel investigated an association between migraine and HSD/hEDS in adolescents by analyzing 1,627,345 Israeli teenagers who were medically assessed before mandatory military service from 1998-2020. Participants had a mean age of 17 and most were male (58%).
HSD/hEDS was diagnosed in those with generalized joint hypermobility associated with symptoms in skeletal muscles, which are used for voluntary movements, or recurrent joint dislocations in the absence of trauma who had no other hereditary connective tissue disorders.
The researchers were unable to distinguish between HSD and hEDS due to a lack of information on family history.
Active migraine was diagnosed by a neurologist in adolescents with at least one migraine attack a month in the past year. When they had at least one attack a week, they were considered to have a high frequency.
A total of 4,686 (0.3%) of the adolescents analyzed were diagnosed with HSD/hEDS, and 52,238 with active migraine (3.2%).
The prevalence of migraine was stable through the study, while the prevalence of HSD/hEDS increased. Adolescents with HSD/hEDS were more likely to have a higher socioeconomic status, achieve at least 11 years of education, and be born in Israel.
Active migraine was more than twice as prevalent in those with HSD/hEDS than those without HSD/hEDS (6.5% vs. 3.2%). This was confirmed after adjusting for sex, age, and socioeconomic, educational, or immigration status.
The association persisted when analyzing only patients without a psychiatric disease and was even stronger in HSD/hEDS patients with highly frequent migraine attacks.
Similarly, the diagnosis of HSD/hEDS in adolescents with active migraine was twice as prevalent than in those without migraine (0.6% vs. 0.3%). The association persisted when the analysis was restricted to patients with a high socioeconomic status, maximum education at the age of enrollment, and those born in Israel.
“This finding is of significant importance because migraine is a main cause of disability and reduced quality of life in adolescents,” the researchers wrote.
Being clinically aware of this association can contribute to an early diagnosis and appropriate migraine treatment with effective pharmacologic and nonpharmacologic strategies. The researchers said more research is needed to “identify the appropriate migraine treatment strategies for people with HSD/hEDS,” however.
The underrepresentation of some religious or ethnic groups, the inclusion of teens with migraine associated with substantial functional impairment, and the inability to distinguish HSD from hEDS were called limitations of the study.