Suboptimal Treatment of Episodic Migraine May Mean Progression to Chronic Migraine

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Improved Acute Treatment of Episodic Migraine May Reduce Risk of Progression

BOSTON, JUNE 26, 2013 – Individuals with episodic migraine (migraine with headache on 14 or fewer days per month) may progress to chronic migraine (migraine with 15 or more headache days per month) at higher rates without optimal treatment, say researchers reporting this week at the International Headache Congress meeting here.

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

Using data from the American Migraine Prevalence and Prevention (AMPP) Study, Dr. Lipton’s team at Montefiore Medical Center and Albert Einstein College of Medicine in New York City and Vedanta Research in Chapel Hill, NC found that those receiving maximally optimized treatment were more than three times less likely to progress to CM than those with very poorly optimized treatment.   The AMPP Study is the largest study of people with severe headache ever conducted, analyzing symptoms and treatment patterns in a representative sample of Americans age 12 and older.

RATES OF OPTIMIZATION AND PROBABILITY OF TRANSITION FROM EM TO CM BASED ON TREATMENT OPTIMIZATION

Level of Acute Treatment Optimization for Migraine

N (%) 

Rate of
CM Onset in following year

Very Poor

308
(6.7%) 

8.1% 

Poor

1,919
(41.5%) 

4.4% 

Moderate

1,132 
(24.5%)

2.9% 

Maximal 

 1,266
(27.4%)

2.5% 

 

 

 

 

 

 

 

 

 

&quo​t;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 [below] shows that as treatment is increasingly optimized, the risk of progression from one year to the next declines."

Study co-author, 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, healthcare 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 which 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."

The International Headache Congress, hosted this year by the American Headache Society, draws about 1,000 headache and migraine researchers and treatment specialists from around the world to hear the latest scientific and clinical information.  This year’s theme – "Revolutionizing Headache Care Through Science" – is a four-day program of teaching and scientific presentations.

STUDY SPONSORSHIP

The AMPP Study was funded through a research grant to the National Headache Foundation (NHF) from McNeil-Janssen Scientific Affairs LLC, Raritan, NJ (MJSA). The AMPP database was donated by MJSA to the NHF for use in various projects. Additional analyses and abstract preparation were supported by a grant from Zogenix, San Diego, CA to the National Headache Foundation.

ABOUT MIGRAINE

Some 36 million Americans have migraine, more than have asthma or diabetes combined.  More than six million Americans have chronic migraine, a highly disabling neurological disorder.  Migraine can be extremely disabling and costly, accounting for more than $20 billion in direct (e.g. doctor visits, medications) and indirect (e.g. missed work, lost productivity) expenses each year in the United States.

ABOUT THE INTERNATIONAL HEADACHE SOCIETY

IHS, founded in the United Kingdom in 1982, is the world's leading membership organization for those with a professional commitment to helping people affected by headache. The purpose is to advance headache science, education, and management, and promote headache awareness worldwide. IHS publishes the international journal Cephalalgia.

ABOUT THE AMERICAN HEADACHE SOCIETY

The American Headache Society (AHS) is a professional society of health care providers dedicated to the study and treatment of headache and face pain. The Society's objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders. Educating physicians, health professionals and the public and encouraging scientific research are the primary functions of this organization. AHS activities include an annual scientific meeting, a comprehensive headache symposium, regional symposia for neurologists and family practice physicians, publication of the journal Headache and sponsorship of the AHS Committee for Headache Education (ACHE).  www.americanheadachesociety.org

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