Suboptimal Treatment of Episodic Migraine Increases Risk of Progression to Chronic Migraine

Link to Article

On-Site Conference Reporting

BREAKING NEWS From the 2013 International Headache Congress—Suboptimal Treatment of Episodic Migraine Increases Risk of Progression to Chronic Migraine

BOSTON—Individuals with episodic migraine may progress to chronic migraine at higher rates without optimal treatment, according to researchers at the International Headache Congress 2013 meeting.

Using data from the American Migraine Prevalence and Prevention (AMPP) Study, Richard B. Lipton, MD, and colleagues at Montefiore Medical Center and Albert Einstein College of Medicine in New York City and Vedanta Research in Chapel Hill, North Carolina, found that patients receiving maximally optimized treatment were more than three times less likely to progress to chronic migraine than were those with poorly optimized treatment.

Study participants with episodic migraine in 2006 who completed the Migraine Treatment Optimization Questionnaire (mTOQ-4) and provided outcome data in 2007 were eligible for the analyses. The mTOQ-4 assesses the frequency of four acute response outcomes: pain free at two hours, sustained pain free at 24 hours, perceived ability to plan daily activities, and perceived control of migraine. Response options include never (0), rarely (0), less than half the time (1), and half the time or more (2). Sum scores ranged from 0 to 8 and were divided into four categories: very poor optimization (0), poor optimization (1 to 5), moderate optimization (6 or 7), and maximal optimization (8). Episodic migraine was defined according to ICHD-2 criteria as 15 or fewer headache days per month on average; chronic migraine was defined as more than 15 headache days per month.

“Of 4,625 eligible subjects with episodic migraine, 48% had very poor or poor treatment optimization,” said Dr. Lipton, lead author of the study. “We found that people in those groups had three times the risk of progression to chronic migraine.”

RATES OF OPTIMIZATION AND PROBABILITY OF TRANSITION FROM EPISODIC MIGRAINE TO CHRONIC MIGRAINE, BASED ON TREATMENT OPTIMIZATION

Level of Acute Treatment Optimization for Migraine	N	Rate of CM Onset in Following Year
Very Poor	308	8.1%
Poor	1,919	4.4%
Moderate	1,132	2.9%
Maximal	1,266	2.5%

“We have seen in the AMPP Study that those with episodic migraine have certain risk factors, such as headache frequency, medication use, and depression, that are associated with increased risk of chronic migraine,” Dr. Lipton said. “This observational study chart shows that as treatment is increasingly optimized, the risk of progression from one year to the next declines.”

Study coauthor, Dawn C. Buse, PhD, noted, “These findings are exciting, as they provide clinical targets for intervention. When we discover factors that increase the risk of progression, health care providers can focus their efforts in those areas to improve care and outcomes. In this case, we have found several factors in acute migraine treatment that may likely improve outcomes, including using medications that work quickly and maintain pain-free results, which allows and empowers people who live with migraine the freedom and confidence to make plans and fully engage in their lives.”