Migraine-associated symptoms change with improvement in youth with migraine: A cohort study

To determine how migraine-associated symptoms change over time, and if they are predictive of outcome at first follow-up visit. Symptoms associated with headache-photophobia and phonophobia, nausea, and/or vomiting-are required criteria for the diagnosis of migraine. Individuals with migraine also report high rates of other symptoms (e.g. lightheadedness, difficulty thinking). We have developed cluster analysis of migraine-associated symptoms (CAMS), which is a composite representation of an expanded set of migraine-associated symptoms that is associated with headache burden. It is unknown if CAMS can change with treatment response or predict outcomes.

We conducted a secondary analysis of prospectively collected clinician-guided patient questionnaire data from youth (6-17 years) with migraine who were seen at a specialized pediatric headache clinic. Data were collected at time of presentation and at the first follow-up within 30 to 90 days from the first visit. CAMS were implemented to assess associations between 11 migraine-associated symptoms. We determined if CAMS changed over time and as a function of treatment outcome, and if CAMS could be used to predict outcome at first follow-up.

Youth with migraine (n = 8008, 67.1% female, median 13 years old) were included in this study. CAMS revealed that the number of reported migraine-associated symptoms decreased at follow-up, particularly for those who improved. Resolution of nausea and vomiting were most common. CAMS at the initial visit differed between youth who improved and youth who did not, but the effect was clinically negligible and could not reliably predict outcome (AUC 0.53).

Migraine-associated symptoms as captured by CAMS changed over time based on whether youth noted improvement or not but was not predictive of who improved at follow-up.