Headache & Pain | Comorbidities in Headache Medicine*
Date: October 20, 2026
Time: 11:00 am to 12:30 pm
Room: Coral 2
Track: Traditional Special Interest Group (SIG)
Session Description
Comorbidities play a significant role in the progression and chronification of migraine and other headache disorders. Understanding these relationships can provide insight into underlying pathophysiology and inform more comprehensive treatment approaches. This session will explore key comorbidities—including hormonal influences (e.g., pituitary disorders), pain and sleep disorders, women’s health considerations, and vascular disease—and discuss their impact on headache management. Faculty will highlight integrated strategies to improve outcomes by addressing both headache disorders and their associated conditions.
Learning Objectives
At the conclusion of this session, attendees will be able to:
- Identify common comorbidities associated with migraine and other headache disorders.
- Explain the role of comorbidities in disease progression and chronification.
- Develop treatment strategies that address both headache disorders and associated comorbidities.
Speakers
- (Chair, Speaker) Nina Riggins, MD, PhD, FANA
- (Speaker) QiLiang Chen, MD, PhD
- (Speaker) Branko Huisa, MD
- (Speaker) Sara Pavitt, MD
- (Speaker) Joanna Fong-Isariyawongse, MD
- (Speaker) Nytzia Licona, DrPH, MPH, CCTDM
- (Speaker) Teshamae Monteith, MD, FAHS, FAAN, FANA
- (Speaker) Yohannes Woldeamanuel, MD (2026 SIG Oral Presenter)
Procedures in the Management of Headache Comorbidities
Description
Headache disorders are frequently accompanied by comorbid conditions that can complicate diagnosis, treatment, and overall patient outcomes. As interventional pain management techniques continue to evolve, procedures such as C2 DRG, sphenopalatine ganglion, and stellate ganglion blocks are emerging as valuable therapeutic options for select patients with complex headache syndromes and associated comorbidities.
This presentation will provide a comprehensive update on interventional approaches for the management of headache symptoms and comorbidities. Participants will review the mechanisms, indications, and current evidence supporting these interventions, discuss patient selection and procedural considerations, and examine their role within a multidisciplinary treatment strategy. Topics will also include emerging techniques and future directions for integrating interventional therapies into comprehensive headache care.
Attendees will leave with a greater understanding of the expanding role of interventional procedures in managing headache comorbidities and practical insights into selecting appropriate patients and incorporating these evidence-based therapies into clinical practice.
Vascular Comorbidities and Headache
Description
Vascular comorbidities are common among individuals with headache disorders, and migraine with aura is recognized as an independent risk factor for cardiovascular and cerebrovascular disease. Appreciating the complex relationship between headache disorders and vascular health is essential for comprehensive risk assessment, individualized treatment planning, and long-term prevention strategies.
This presentation will examine the interplay between vascular comorbidities and headache disorders, with a particular focus on migraine and cerebrovascular disease. Participants will review the current evidence linking migraine with aura to cardiovascular risk, explore shared pathophysiological mechanisms underlying headache and vascular disease, and discuss the impact of vascular comorbidities on headache management in patients with a history of stroke. Topics will also include integrated approaches to risk factor modification, preventive therapy, and multidisciplinary care that address both headache disorders and associated vascular conditions to improve overall neurological health.
Attendees will leave with a greater understanding of the relationship between headache disorders and vascular disease and practical strategies for incorporating vascular risk assessment and management into the care of patients with migraines and other primary headache disorders.
Pediatric Headache and Comorbidities
Description
Migraine in children and adolescents is frequently accompanied by comorbid conditions that can influence clinical presentation, symptom severity, treatment response, and overall disease burden. Recognizing and addressing these comorbidities is essential to developing an effective, individualized approach to pediatric migraine management.
This presentation will review the prevalence and clinical significance of common comorbidities associated with pediatric migraine, including psychiatric, gastrointestinal, sleep, neurological, and other medical conditions. Participants will examine how these conditions may contribute to migraine symptoms, headache-related disability, and quality of life, and explore how their recognition can influence diagnostic evaluation and treatment selection. The session will also discuss strategies for incorporating comorbidities into a comprehensive, patient-centered approach to migraine care.
Attendees will leave with a greater understanding of the clinical impact of comorbid conditions in children and adolescents with migraine and practical insights into identifying relevant comorbidities and integrating them into individualized treatment plans.
The Vicious Cycle: Sleep, Pain, and the Neurobiology of a Self-Perpetuating Loop
Description
Sleep disturbance and pain exist in a complex bidirectional relationship that contributes to symptom persistence, disability, and reduced quality of life across a wide range of neurologic conditions, including headache disorders. Emerging evidence suggests that sleep disturbance is not merely a consequence of pain but may be a key driver of pain sensitivity, chronicity, and amplification through effects on pain processing pathways in the brain and nervous system.
This presentation will examine the neurobiological mechanisms linking sleep and pain, including the effects of sleep deprivation on peripheral and central pain modulation, pain thresholds, affective processing, and reward pathways. Participants will explore how disrupted sleep alters pain perception and contributes to a self-perpetuating cycle of worsening pain and poor sleep. The session will also review the clinical consequences of coexisting pain and sleep disturbance and discuss evidence-based approaches to interrupting this cycle.
Attendees will leave with a greater understanding of the sleep-pain relationship and practical strategies to incorporate sleep assessment and sleep-focused interventions into the management of patients with headache and other chronic pain conditions.
Role of Multidisciplinary Team in the Management of Headache and Comorbidities
Description
Headache disorders are frequently accompanied by complex medical, psychological, and neurological comorbidities that require coordinated, patient-centered care. For Veterans and military service members, these challenges are often compounded by conditions such as traumatic brain injury, post-traumatic stress disorder, chronic pain, and sleep disturbances, making multidisciplinary management essential to optimizing outcomes.
This presentation will explore how multidisciplinary team-based care and the use of clinical data enhance the management of headache disorders and associated comorbidities in Veterans and military service members. Participants will examine collaborative models of care that integrate neurology, pain management, behavioral health, rehabilitation, and other specialties to provide comprehensive treatment. Topics will also include how clinical data and quality improvement initiatives can inform treatment decisions, monitor outcomes, and support personalized care for this unique patient population.
Attendees will leave with a greater understanding of the value of multidisciplinary collaboration and data-driven care in the management of headache disorders and practical strategies for implementing comprehensive, evidence-based approaches to improve outcomes for Veterans, military service members, and other patients with complex headache conditions.
What Do We Know About Factors of Migraine Chronification
Description
The progression from episodic to chronic migraine is influenced by a complex interplay of biological, clinical, behavioral, and social factors. Identifying patients at risk for migraine chronification provides an important opportunity to intervene early, reduce disability, and improve long-term outcomes.
This case-based presentation will examine the modifiable and non-modifiable factors associated with migraine chronification. Participants will review the impact of suboptimal acute headache management, medication overuse, comorbid mental health disorders, chronic pain conditions, sleep disturbances, and respiratory disease on migraine progression. Topics will also include the influence of lifestyle and metabolic factors, as well as barriers to care—including financial constraints and limited access to appropriate treatment—that contribute to undertreatment and increasing disease burden. Through illustrative clinical cases, attendees will learn practical strategies to identify individuals at greatest risk for chronification, optimize preventive and acute treatment, and implement evidence-based interventions that may reduce the transition to chronic migraine.
Attendees will leave with a greater understanding of the factors that contribute to migraine chronification and practical approaches to early identification, comprehensive risk assessment, and individualized management aimed at preventing chronic migraine and improving patient outcomes.
Updates on Women's Health and Headache
Description
Headache disorders disproportionately affect women and are frequently influenced by hormonal, reproductive, and other sex-specific factors. Emerging evidence also highlights a substantial burden of medical and psychological comorbidities that can affect disease severity, treatment response, and overall quality of life, emphasizing the need for comprehensive, multidisciplinary care.
This presentation will provide an update on the evolving understanding of women’s health and headache, with a focus on the growing evidence surrounding comorbidities in women with headache disorders. Participants will review how these comorbid conditions influence clinical outcomes, explore the impact of hormonal and reproductive factors on headache management, and discuss multidisciplinary strategies for delivering individualized, patient-centered care. Topics will also include recent advances that can improve outcomes in women with headache disorders.
Attendees will leave with a greater understanding of the complex relationship between women’s health, headache disorders, and associated comorbidities, along with practical strategies for optimizing outcomes through comprehensive, multidisciplinary care.
The Endometriosis-Migraine Visibility Gap: A 13-Million Patient Meta-Analysis of Shared Neuro-Gynecological Biology
Description
Advances in neuro-gynecological research have transformed the understanding of endometriosis and migraine, revealing a complex biological blueprint that integrates these two conditions as classic Chronic Overlapping Pain Conditions (COPCs). Recent large-scale data reveals a robust shared architecture involving neurovascular cross-talk, estrogen-dependent central sensitization, and synergistic neuro-inflammatory pathways. These discoveries are reshaping clinical approaches to diagnosis, patient risk stratification, and the development of non-hormonal precision therapies. This presentation will review the evolving neuro-gynecological landscape of the endometriosis-migraine comorbidity, examining the spectrum of shared pathophysiological mechanisms, the masking effects of clinical confounding, and the systemic diagnostic visibility gaps that obscure this syndromic relationship in standard medical networks.
Participants will explore the profound methodological challenges in tracking this comorbidity across different clinical and administrative settings. The session will dissect the newly identified tri-modal distribution of disease prevalence, demonstrating how data-capture styles create an artificial “administrative floor” versus an accurate “biological ceiling.” We will analyze how restrictive, one-year ICD billing codes capture a mere 4.5% to 4.7% prevalence, whereas specialized clinic-based cohorts employing direct patient interviews and formalized ICHD-3 diagnostic criteria reveal the true biological reality, with migraine prevalence consistently reaching 54% to 70%. Through this lens, attendees will evaluate the systematic 11x-to-14x under-reporting gap within traditional hospital billing networks, which effectively hides up to 90% of the active biological burden from epidemiological view.
Attendees will explore how characterizing this shared biology provides an innovative pathway for therapeutic translation, supporting the clinical repurposing of established migraine therapies, such as CGRP blockers, as novel, non-hormonal, and non-opioid strategies for gynecological pain management. Attendees will leave with a greater understanding of the neuro-gynecological basis of COPCs and practical insights into applying formalized phenotyping to improve diagnosis, guide clinical decision-making, and implement personalized therapeutic strategies.
