Abstract：
OBJECTIVE: To evaluate headache comorbidity in a cohort of patients with functional movement disorders by assessing the prevalence, clinical characteristics, and temporal relationship of headache with the onset of functional symptoms.
BACKGROUND: Functional movement disorders are common and potentially treatable. Although headache is frequent in these patients, few studies have evaluated their headache features.
METHODS: This observational cohort study included consecutive patients with functional movement disorders evaluated in our Functional Movement Disorders Unit between October 2021 and November 2022. Clinical and demographic features from clinical charts were reviewed, and patients completed a self-administered questionnaire designed by the authors that included headache characteristics, disease duration, treatments received, and the Headache Impact Test-6. Headache type was classified as per the Classification of Headache Disorders, third edition (ICHD-3).
RESULTS: A total of 51 patients with functional movement disorders were included. Of those, 40 (78%) reported having recurrent headache. Headache intensity was moderate-severe in 33/40 (83%), and about two-thirds experienced headache >9 days/month. Disability secondary to headache was high (median [interquartile range] Headache Impact Test-6 score 62 [49-66]). Based on the ICHD-3, 23/40 (58%) of patients with headache met the criteria for migraine or probable migraine, 11/40 (27%) for tension-type headache, two of 40 (5%) for new daily persistent headache, and one of 40 (3%) for primary exercise headache, while three of 40 (7%) were unclassifiable. The onset of headache occurred before the functional movement disorder in 28/40 (70%), after the functional movement disorder in five of 40 (12%), and simultaneously in six of 40 (15%). In this last group, four of the six (67%) patients described a daily headache from the onset, and two met the criteria for new daily persistent headache.
CONCLUSIONS: Headache is a frequent condition in patients with functional movement disorders and an additional burden of disability beyond their motor symptoms. We found that, besides migraine and tension-type headache, new daily persistent headache may be a comorbid phenotype in patients with functional movement disorders and should be further studied in larger prospective studies.
BACKGROUND: Functional movement disorders are common and potentially treatable. Although headache is frequent in these patients, few studies have evaluated their headache features.
METHODS: This observational cohort study included consecutive patients with functional movement disorders evaluated in our Functional Movement Disorders Unit between October 2021 and November 2022. Clinical and demographic features from clinical charts were reviewed, and patients completed a self-administered questionnaire designed by the authors that included headache characteristics, disease duration, treatments received, and the Headache Impact Test-6. Headache type was classified as per the Classification of Headache Disorders, third edition (ICHD-3).
RESULTS: A total of 51 patients with functional movement disorders were included. Of those, 40 (78%) reported having recurrent headache. Headache intensity was moderate-severe in 33/40 (83%), and about two-thirds experienced headache >9 days/month. Disability secondary to headache was high (median [interquartile range] Headache Impact Test-6 score 62 [49-66]). Based on the ICHD-3, 23/40 (58%) of patients with headache met the criteria for migraine or probable migraine, 11/40 (27%) for tension-type headache, two of 40 (5%) for new daily persistent headache, and one of 40 (3%) for primary exercise headache, while three of 40 (7%) were unclassifiable. The onset of headache occurred before the functional movement disorder in 28/40 (70%), after the functional movement disorder in five of 40 (12%), and simultaneously in six of 40 (15%). In this last group, four of the six (67%) patients described a daily headache from the onset, and two met the criteria for new daily persistent headache.
CONCLUSIONS: Headache is a frequent condition in patients with functional movement disorders and an additional burden of disability beyond their motor symptoms. We found that, besides migraine and tension-type headache, new daily persistent headache may be a comorbid phenotype in patients with functional movement disorders and should be further studied in larger prospective studies.
摘要：
目的：通过评估功能性运动障碍患者的患病率来评估头痛合并症，临床特征,以及头痛与功能性症状发作的时间关系。
背景：功能性运动障碍是常见且可治疗的。虽然这些患者经常头痛，很少有研究评估他们的头痛特征。
方法：这项观察性队列研究包括2021年10月至2022年11月在我们的功能性运动障碍单位评估的连续功能性运动障碍患者。回顾了来自临床图表的临床和人口统计学特征，患者完成了作者设计的自我管理问卷，其中包括头痛特征，疾病持续时间,接受治疗,和头痛冲击测试-6。根据头痛疾病的分类对头痛类型进行分类，第三版(ICHD-3)。
结果：共纳入51例功能性运动障碍患者。其中,40人（78%）报告头痛复发。33/40的头痛强度为中度-重度（83％），约三分之二的人经历头痛>9天/月。继发头痛的残疾很高（中位数[四分位数范围]头痛影响测试-6评分62[49-66]）。根据ICHD-3，23/40（58％）的头痛患者符合偏头痛或可能的偏头痛标准，11/40（27％）紧张型头痛，40人中有2人（5%）用于新的每日持续性头痛，和40（3％）的原发性运动头痛之一，而40人中有3人(7%)无法分类。在28/40（70％）的功能性运动障碍之前发生头痛，在40人中有5人(12%)出现功能性运动障碍后，同时在40人中有6人(15%)。在最后一组中，六名患者中有四名(67%)描述从发病开始每天头痛，两个符合新的每日持续性头痛的标准。
结论：头痛是功能性运动障碍患者的常见病，除了运动症状外，还有额外的残疾负担。我们发现,除了偏头痛和紧张型头痛，新的每日持续性头痛可能是功能性运动障碍患者的合并症表型,应在更大的前瞻性研究中进一步研究.
背景：功能性运动障碍是常见且可治疗的。虽然这些患者经常头痛，很少有研究评估他们的头痛特征。
方法：这项观察性队列研究包括2021年10月至2022年11月在我们的功能性运动障碍单位评估的连续功能性运动障碍患者。回顾了来自临床图表的临床和人口统计学特征，患者完成了作者设计的自我管理问卷，其中包括头痛特征，疾病持续时间,接受治疗,和头痛冲击测试-6。根据头痛疾病的分类对头痛类型进行分类，第三版(ICHD-3)。
结果：共纳入51例功能性运动障碍患者。其中,40人（78%）报告头痛复发。33/40的头痛强度为中度-重度（83％），约三分之二的人经历头痛>9天/月。继发头痛的残疾很高（中位数[四分位数范围]头痛影响测试-6评分62[49-66]）。根据ICHD-3，23/40（58％）的头痛患者符合偏头痛或可能的偏头痛标准，11/40（27％）紧张型头痛，40人中有2人（5%）用于新的每日持续性头痛，和40（3％）的原发性运动头痛之一，而40人中有3人(7%)无法分类。在28/40（70％）的功能性运动障碍之前发生头痛，在40人中有5人(12%)出现功能性运动障碍后，同时在40人中有6人(15%)。在最后一组中，六名患者中有四名(67%)描述从发病开始每天头痛，两个符合新的每日持续性头痛的标准。
结论：头痛是功能性运动障碍患者的常见病，除了运动症状外，还有额外的残疾负担。我们发现,除了偏头痛和紧张型头痛，新的每日持续性头痛可能是功能性运动障碍患者的合并症表型,应在更大的前瞻性研究中进一步研究.
