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Predictive index for the onset of medication overuse headache in migraine patients
1Department of Pathophysiology, Showa University School of Pharmacy, Tokyo 142-8555, Japan.
Abstract:
Migraine patients are particularly prone to develop medication overuse headache (MOH). However, the risk factors for the transformation of migraine to MOH are still not clear. We investigated gene polymorphisms, personality traits, and characteristics of headache and lifestyle in 47 migraine patients (aged 36.4 ± 10.3) and 22 MOH patients (aged 39.6 ± 9.9) who progressed from migraine and made a scoring system for a predictive index (PI) of the onset of MOH in patients with migraine. By multivariate logistic stepwise regression analysis, type of migraine, regular and sufficient dietary intake, and methylenetetrahydrofolate reductase (MTHFR) C677T (rs1801133) and dopamine D2 receptor (DRD2) C939T (rs6275) polymorphisms were selected as significant factors that contribute independently to the development from migraine to MOH (P < 0.05). The regression coefficients (β) of these four selected factors were approximated and scored. The PI score in MOH patients (7.32 ± 1.60) was significantly higher than that in migraine patients (4.62 ± 1.83, P < 0.001). The proposed scoring system should in the future be the object of larger studies to confirm its validity.
Insights
Migraine patients may develop medication overuse headache (MOH) due to specific migraine types, diet, and genetic factors like MTHFR and DRD2 gene polymorphisms. A predictive index score can identify individuals at higher risk for MOH onset.
Area of Science:
- Neurology
- Genetics
- Epidemiology
Background:
- Medication overuse headache (MOH) is a common complication in migraine patients.
- Identifying risk factors for migraine transformation to MOH is crucial for prevention.
- Current understanding of these risk factors remains incomplete.
Purpose of the Study:
- To investigate gene polymorphisms, personality traits, headache characteristics, and lifestyle factors associated with migraine progression to MOH.
- To develop a predictive index (PI) scoring system for MOH onset in migraine patients.
Main Methods:
- A case-control study involving 47 migraine patients and 22 patients who transitioned from migraine to MOH.
- Multivariate logistic stepwise regression analysis to identify independent risk factors.
- Development and validation of a predictive index (PI) score.
Main Results:
- Migraine type, regular dietary intake, methylenetetrahydrofolate reductase (MTHFR) C677T, and dopamine D2 receptor (DRD2) C939T polymorphisms were significant independent predictors of MOH development (P < 0.05).
- The developed PI score was significantly higher in MOH patients (7.32 ± 1.60) compared to migraine patients (4.62 ± 1.83, P < 0.001).
Conclusions:
- Specific migraine types, dietary habits, and genetic variations (MTHFR, DRD2) are key factors in the migraine to MOH transformation.
- The proposed predictive index offers a potential tool for identifying individuals at risk of developing MOH.
- Larger studies are needed to validate the predictive index's clinical utility.
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