Fluctuations in episodic and chronic migraine status over the course of 1 year: implications for diagnosis, treatment and clinical trial design

The Journal of Headache and Pain

Research Article

Aubrey Manack Adams¹  Ann I. Scher²  Daniel Serrano³  Dawn C. Buse⁴  Walter (Buzz) F. Stewart⁵  Richard B. Lipton⁶  Michael L. Reed⁷ 

[1] Allergan plc, Irvine, CA, USA;Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA;Endpoint Outcomes, Boston, MA, USA;Montefiore Medical Center, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA;Sutter Health, Walnut Creek, CA, USA;The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA;Montefiore Headache Center; Department of Neurology and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA;Vedanta Research, Chapel Hill, NC, USA;

关键词: Migraine;    Chronic migraine;    Episodic migraine;    Longitudinal;    Remission;   

DOI  :  10.1186/s10194-017-0787-1

 received in 2017-06-01, accepted in 2017-07-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundRelatively little is known about the stability of a diagnosis of episodic migraine (EM) or chronic migraine (CM) over time. This study examines natural fluctuations in self-reported headache frequency as well as the stability and variation in migraine type among individuals meeting criteria for EM and CM at baseline.MethodsThe Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a longitudinal survey of US adults with EM and CM identified by a web-questionnaire. A validated questionnaire was used to classify respondents with EM (<15 headache days/month) or CM (≥15 headache days/month) every three months for a total of five assessments. We described longitudinal persistence of baseline EM and CM classifications. In addition, we modelled longitudinal variation in headache day frequency per month using negative binomial repeated measures regression models (NBRMR).ResultsAmong the 5464 respondents with EM at baseline providing four or five waves of data, 5048 (92.4%) had EM in all waves and 416 (7.6%) had CM in at least one wave. Among 526 respondents with CM at baseline providing four or five waves of data, 140 (26.6%) had CM in every wave and 386 (73.4%) had EM for at least one wave. Individual plots revealed striking within-person variations in headache days per month. The NBRMR model revealed that the rate of headache days increased across waves of observation 19% more per wave for CM compared to EM (rate ratio [RR], 1.19; 95% CI, 1.13–1.26). After adjustment for covariates, the relative difference changed to a 26% increase per wave (RR, 1.26; 95% CI, 1.2–1.33).ConclusionsFollow-up at three-month intervals reveals a high level of short-term variability in headache days per month. As a consequence, many individuals cross the CM diagnostic boundary of ≥15 headache days per month.Nearly three quarters of persons with CM at baseline drop below this diagnostic boundary at least once over the course of a year. These findings are of interest in the consideration of headache classification and diagnosis, the design and interpretation of epidemiologic and clinical studies, and clinical management.

【 授权许可】

CC BY   
© The Author(s). 2017