In this study, we analyzed clinical data to examine the correlation between neuropathic symptoms and headaches by reviewing the medical records of Massachusetts General Hospital (MGH) from 2018-2020.   

In this retrospective study, medical records of adults (older than the age of 18 years), primarily from the north-eastern United States, who had sensory and autonomic symptoms and a distal-leg, PGP9.5-immunolabeled skin biopsy at the MGH from 9/1/2018 to 12/31/2019 were reviewed.

Four hundred and twenty medical records from patients who had diagnostic skin biopsies for evaluation of SFN are included in this study.  Among these patients (106 males and 314 females), the overall prevalence of SNS is 55% with a female predominance (77%).    

In the SNS group, 44% of patients have a history of headache with a majority (69%) of these cases are diagnosed with chronic migraine.  Female patients with SNS are more prone to develop headache (50% females vs 26% males, p<0.05) and migraine (39% female vs 15% male, p< 0.05) compared the male.    

Only 25% of SNS patients have positive skin biopsy results with clear gender discrepancy (male: female= 34%: 22%, p< 0.0001). The majority of patients with headaches do not have a positive skin biopsy result (78% in the female; 69% in the male). A statistical correlation between positive skin biopsy results and headache was not established (p=0.45). 

Our results demonstrated the increasing prevalence of chronic headaches, especially chronic migraine, among female patients with SNS.  The prevalence of headache in SNS patients is not associated with positive skin biopsy results.