Fatigue in migraine patients and its clinical correlates: a large-scale hospital-based study

Despite significant impact among various neurological disorders, fatigue remains under-investigated in migraine. The study aimed to evaluate (1) the prevalence and clinical correlates of fatigue, and (2) the association between chronic migraine (CM) and fatigue in patients with migraine. This retrospective cross-sectional study involved patients with migraine (International Classification of Headache Disorders, Third Edition) from a community hospital and a tertiary medical center. Headache profiles, Migraine Disability Assessment (MIDAS), Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), and cognitive symptoms (absent/mild/moderate/severe) were evaluated. Fatigue was defined as a Fatigue Severity Scale (FSS) score of ≥ 4.0. Logistic regression and mediation analysis were carried out to determine the relationship between CM and fatigue. Among 2,403 migraine patients (1,898 F/505 M, mean age 38.7 ± 11.8 years), 1,369 (57.0%) had fatigue. The presence of fatigue was associated with higher migraine frequency (14.4 ± 9.9 vs. 11.6 ± 9.4 days/month, p < 0.001), greater disability (MIDAS 37.8 ± 47.8 vs. 20.3 ± 31.0, p < 0.001), more psychological disturbances (HADS 17.7 ± 7.7 vs. 11.3 ± 6.6, p < 0.001), poorer sleep (PSQI 10.7 ± 3.9 vs. 8.2 ± 3.8, p < 0.001), and a higher percentage of moderate-to-severe cognitive symptoms (26.5% vs. 8.4%, p < 0.001). Fatigue was more common in CM than in episodic migraine (EM) (66.2% vs. 55.3%, p < 0.001), although the association was not significant after controlling for potential confounders (odds ratio = 1.00 [95% confidence interval = 0.80–1.25], p = 0.991). The effect of CM (vs. EM) on fatigue severity was completely mediated by symptoms of anxiety and depression (indirect effect = 0.252 [0.198–0.309]) (53.1% of total effect) and sleep quality (indirect effect = 0.208 [0.164–0.258]) (43.8% of total effect), without significant direct effect (0.015 [-0.101-0.130]). More than half of migraine patients had fatigue, and fatigue was primarily associated with depression, anxiety, sleep disturbances, and migraine-related disability. Although fatigue was more common in CM, the association was accounted for or mediated by potential confounders. Considering its prevalence and impact, fatigue in migraine deserves more attention.