A woman would get frequent throbbing headaches accompanied by sensitivity to light, dizziness and nausea. These headaches became so debilitating that she chose to undergo trigger site deactivation surgery for relief.

But could she now be at an increased risk for carpal tunnel syndrome?

Compression neuropathy of the head and neck that cause migraines and entrapment neuropathies of the extremities, such as carpal tunnel syndrome, are usually thought of as separate clinical entities. But similar presentations and treatment options may be indicative of a shared pathogenesis and the possibility of patients being susceptible to both disorders.

Noticing the similarities between the median nerve compression in carpal tunnel syndrome and the compression of the greater occipital nerve at the occiput in compression headaches, Gfrerer et al. wanted to examine the relationship between nerve compression headaches and carpal tunnel syndrome, as well as other nerve compression syndromes.

These similarities, they believed, could link patients that undergo trigger site deactivation surgery for headaches with a higher likelihood of experiencing carpal tunnel or other compression neuropathy syndromes.

Carpal Tunnel Syndrome in Compression Headache Patients

In their retrospective chart review, Gfrerer et al. chose 137 nerve compression headache patients that had undergone trigger site deactivation surgery. Patients were asked to complete a Migraine Headache Index questionnaire, which is calculated through scores of migraine frequency, duration and pain on a scale of 0 to 10.

Here are some key takeaways:

  • 14 had documented carpal tunnel syndrome in their medical record, and all of them had undergone carpal tunnel release.
    • Of these 14 patients, 21% were men, with an average age of 67 years, and 79% were women with an average age of 50 years.
        • Authors note that patients’ age and sex-specific carpal tunnel syndrome rates are higher than in the general population.
    • The cumulative prevalence of upper extremity nerve compression syndromes in trigger site deactivation surgery patients was 16.7% (this included carpal tunnel syndrome, thoracic outlet syndrome, and cubital tunnel syndrome), which is a 1.8- to 3.8-fold higher prevalence of upper extremity nerve compression syndromes compared to the general population.
    • A significant decrease in Migraine Headache Index was noted for all patients from preoperatively to postoperatively.
        • However, there was no significant difference in outcome between patients who had other nerve compression syndromes and those who did not.

Based on their findings, the study authors report that  nerve compression headache trigger site deactivation patients are correlated with a higher chance of experiencing carpal tunnel syndrome (or other compression neuropathy syndromes), which is in agreement with their hypothesis. This suggests that compression neuropathies of the head/neck and extremities should become an integral part of a formal peripheral nerve surgery curriculum.

However, they note that given their small sample size, their data may not reflect the true prevalence of the disorders. Further, a prospective study, screening all patients (regardless of presentation/evidence) via clinical evaluation and electromyography would be needed to fully capture prevalence of upper extremity nerve compression and a potential causal link. Lastly, the possibility that patients who undergo carpal tunnel syndrome surgery may be more likely to seek headache surgery and vice versa.

In the future, they recommend that patients who have an upper extremity neuropathy be screened for headache/migraine, while patients who undergo trigger site deactivation surgery should be screened for upper extremity nerve entrapment syndromes. Both groups, they urge, should be evaluated by a specialist as well.

Carpal Tunnel Syndrome and Migraines: The First Patient-Reported Association

While Gfrerer et al.’s study brought to light the association between carpal tunnel syndrome and nerve compression headaches, Law et al. were the first to report an association between the two in their 2015 study published in PRS Global Open.

Looking at data from 25,880 participants in the 2010 National Health Interview Survey, they found that 952 participants had reported having carpal tunnel syndrome, while 4,212 had reported having migraine headaches.

The prevalence of carpal tunnel syndrome in patients with migraine headache was more than two times likely than in patients without migraines.

However, the study authors noted that the survey question for migraines was worded as “migraine or severe headache;” this ambiguity of phrasing could have led to false-positive responses and serves as an important limitation for their study. Law et al. also acknowledge that their study relied on a survey in which patients’ diagnoses were not necessarily confirmed by a medical professional.

They note that further research is needed to determine whether migraines should be used as an early predictor of carpal tunnel syndrome.

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