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Published on: June 2, 2014
Rates and risk factors for migraine progression using multiple definitions of progression: Results of the
Dawn C Buse1, E Jolanda Muenzel2, Anthony J Zagar2
1Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA.
Objective:
To estimate rates of migraine progression and assess predictors of progression in a large, longitudinal cohort study using the traditional definition and two alternative definitions of migraine progression.
Background:
Traditionally, migraine progression is defined as moving from episodic migraine (EM) with ≤ 14 monthly headache days (MHD) to chronic migraine (CM) with ≥ 15 MHDs of which 8 are attributable to migraine. This definition does not take into account changes in the full range of potential headache days, disability, or impact on function.
Methods:
The Observational Survey of the Epidemiology, Treatment, and Care of Migraine (OVERCOME) study identified, characterized, and followed a representative sample of adults with migraine in the United States. Migraine was defined based on the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. We estimated rates of migraine progression at 1 year of follow-up using three definitions: (1) traditional EM-to-CM transition, (2) increase of ≥ 5 MHDs (MHD progression), and (3) increase of ≥ 5 points on the Migraine Disability Assessment (MIDAS) scale (MIDAS progression). The analysis identified sociodemographic, clinical, and migraine-related characteristics associated with each definition of progression from a set of 67 candidates and then determined the association with progression for each candidate predictor and each definition of progression.
Results:
A total of 11,634 participants met ICHD-3 criteria for migraine at baseline and completed the 1-year follow-up survey. The average age was 48.2 years, and average years living with migraine was 22.8 years. The sample was 75.6% female (8793/11,634), 84.4% White (9814/11,634), 6.5% Black (757/11,634), and 7.6% Hispanic (889/11,634). The majority (89.2%, 10,374/11,634) had EM at baseline, and among these, 4.7% progressed to CM over 1 year of follow-up. Rates of progression at 1 year were higher using other definitions of progression, with 9.6% (1087/11,329) reporting an increase in ≥ 5 MHDs and 21.7% (2519/11,630) reporting an increase of ≥ 5 MIDAS points. Across all three definitions of progression, ever taking preventive medications for migraine placed people at lower odds of progressing (odds ratio [95% confidence interval]: EM-to-CM transition, 0.7 [0.57-0.85]; MHD progression, 0.9 [0.75-1.00]; MIDAS progression, 0.8 [0.73-0.91]), while the presence of depression placed people at higher odds of progressing (odds ratio [95% confidence interval]: EM-to-CM transition, 1.3 [1.05-1.69]; MHD progression, 1.4 [1.21-1.67]; MIDAS progression, 1.2 [1.04-1.34]).
Conclusion:
This work expands the concept of migraine progression, exploring two alternative definitions that modify the potential range of MHD changes and take disability into account. This analysis identified never having used preventive medications for migraine and presence of depression as risk factors across all three definitions of progression. This work may more accurately identify persons with progression and at risk of migraine progression, setting the stage for trials of preventive intervention and ultimately more effective practice.
Insights
Migraine progression can be identified using new definitions that consider headache days and disability. Never using preventive medication and having depression are key risk factors for migraine worsening.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Migraine progression is traditionally defined by an increase in monthly headache days (MHDs).
- This traditional definition may not capture the full spectrum of migraine worsening, including disability and functional impact.
- Alternative definitions are needed to better understand and identify migraine progression.
Purpose of the Study:
- To estimate rates of migraine progression using traditional and alternative definitions.
- To identify predictors of migraine progression in a large, longitudinal cohort.
- To expand the understanding of migraine progression beyond episodic to chronic migraine transitions.
Main Methods:
- The Observational Survey of the Epidemiology, Treatment, and Care of Migraine (OVERCOME) study followed 11,634 adults with migraine.
- Progression was assessed using three definitions: traditional episodic migraine (EM) to chronic migraine (CM) transition, a ≥5 MHD increase, and a ≥5 point Migraine Disability Assessment (MIDAS) increase.
- Predictors of progression were identified from 67 candidate characteristics.
Main Results:
- At 1-year follow-up, 4.7% of participants with EM progressed to CM.
- Higher progression rates were observed with alternative definitions: 9.6% for MHD progression and 21.7% for MIDAS progression.
- Never having used preventive migraine medications and the presence of depression were associated with increased odds of migraine progression across all definitions.
Conclusions:
- Alternative definitions of migraine progression, incorporating MHDs and disability, provide a broader perspective.
- Never using preventive medications and having depression are significant risk factors for migraine progression.
- These findings can improve the identification of individuals at risk for progression and inform preventive strategies.
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