The Relationship Between Carpal Tunnel Syndrome And Migraine Headache, A Diathesis?
Christian Chartier, Lisa Gfrerer, MD, PhD, William G. Austen, Jr., MD.
Massachusetts General Hospital, Boston, MA, USA.
PURPOSE: Compression of extra-cranial sensory nerves by surrounding tissues can provoke migraine headache pain (MH). We have demonstrated that at the occipital trigger site, the greater occipital nerve is surrounded by thickened trapezius fascia in 94% of patients1.This pathology is similar to that found in other nerve compression syndromes such as carpal tunnel syndrome (CTS). We hypothesized that MH surgery patients may have a higher prevalence of CTS than the general population.
METHODS: 108 migraine surgery patients who also have primary care with complete medical records at our institution were included in a retrospective chart review. Subjects with clinically certain diagnosis of CTS were identified and prevalence was compared to general population data.
RESULTS: Average age was 47.6 ±13.8 years (19-74). Prevalence of CTS was 13.8% (n=15). In the CTS group, eleven subjects presented with physician confirmed diagnosis of CTS that led to surgical release, one had EMG documented CTS and three had a physician confirmed diagnosis of CTS with no surgery to date. The prevalence of clinically certain CTS in the general population ranges from 3.8%2 to 7.8%3.
CONCLUSION: CTS is significantly more prevalent in patients undergoing migraine surgery than the general population. (1.7- 3.5-fold). These remarkable findings warrant further exploration. We suspect that patients with nerve compression syndromes are more susceptible to development of this disease complex through shared pathogenesis, genetics and risk factors. This may have important clinical implications for evaluation of patients with CTS and/or MH.
1Gfrerer, L., Hansdorfer M., Ortiz R., Nealon K., Austen WG. Occipital neuralgia/ migraine: Intra- operative evidence for extracranial pathology. Paper presented at: American Society of Peripheral Nerve Meeting; Feb 1-3 2019; Palm Desert, CA.
2Atroshi, I., Gummesson, C., Johnsson, R., Ornstein, E., Ranstam, J., Rosen, I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999;282:153-158.
3Dale, A. M., Harris-Adamson, C., Rempel, D., et al. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health 2013;39:495-505.
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