Chronic versus episodic migraine: The 15‐day threshold does not adequately reflect substantial differences in disability across the full spectrum of headache frequency

Aim The aim of this article is to compare 90-day and 30-day recall of Pediatric Migraine Disability Assessment (PedMIDAS) elements and headache frequency against daily entries from an Internet headache diary among pediatric patients and their parents. Methods In a prospective cohort study, patients aged 10–18 years with episodic migraine or probable migraine completed a 90-day Internet-based headache diary that incorporated PedMIDAS questions. Following the 90-day diary period, patients and parents completed modified PedMIDAS instruments to assess 90-day and 30-day recall. Intraclass correlation coefficients (ICC) were calculated to measure recall reliability. The Kruskal-Wallis and Jonckheere-Terpstra tests were used to explore recall accuracy as it relates to each participant’s self-reported confidence in recall and to patient age. Results Fifty-two subjects completed 90 consecutive diary entries. Comparing 30-day to 90-day recall of PedMIDAS elements, ICC scores improved by 26.2% (patients) and 17.5% (parents). Patients had better recall than their parents for all study measures. Self-reported confidence in recall and patient age had limited and inconsistent effects on recall accuracy. Conclusion The optimal recall interval to assess migraine disability must balance recall accuracy with generalizability across a range of headache frequencies. When compared to daily diary entries, recall accuracy of PedMIDAS elements and headache frequency improves at 30 days compared to 90 days. Parent report of migraine disability should not be used as a replacement for patient report.

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PRM225 - EVALUATING PREVIOUS MIGRAINE HEADACHE FREQUENCY STATISTICAL MODELLING APPROACHES USING AN INDEPENDENT DATASET FROM THE EVOLVE STUDIES IN EPISODIC MIGRAINE

Value in Health ◽

10.1016/j.jval.2018.09.2343 ◽

2018 ◽

Vol 21 ◽

pp. S394-S395

Author(s):

M Paget ◽

A. Tockhorn-Heidenreich

Keyword(s):

Migraine Headache ◽

Statistical Modelling ◽

Episodic Migraine ◽

Headache Frequency ◽

Independent Dataset ◽

Modelling Approaches

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The clinical and public health implications and risks of widening the definition of chronic migraine

Cephalalgia ◽

10.1177/0333102419895777 ◽

2019 ◽

Vol 40 (4) ◽

pp. 407-410 ◽

Cited By ~ 4

Author(s):

Martina Guglielmetti ◽

Alberto Raggi ◽

Raffaele Ornello ◽

Simona Sacco ◽

Domenico D’Amico ◽

...

Keyword(s):

Public Health ◽

Chronic Migraine ◽

High Frequency ◽

Episodic Migraine ◽

Headache Frequency ◽

Allocation Of Resources ◽

Independent Entity ◽

Definition Of ◽

The Impact

Background The definition of chronic migraine has long been debated. Recently, it was suggested to define subjects with at least 8/migraine days as chronic migraine; that is, incorporating so-called high frequency episodic migraine (eight or more migraine days but less than 15 headache days per month). Methods We addressed the possible problems that might arise based on this proposal accounting for clinical, pathophysiological, impact and public health aspects. Results and conclusions Defining chronic migraine on the basis of headache frequency alone does not account for clinical and pathophysiological aspects, as well as for the impact of chronic migraine in terms of disability and quality of life. Moreover, it is potentially harmful for patients in terms of allocation of resources. These issues are discussed in the present manuscript, and we support the idea of defining high frequency episodic migraine as an independent entity as a viable path to follow.

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Assessment of peripheral biomarkers potentially involved in episodic and chronic migraine: a case-control study with a focus on NGF, BDNF, VEGF, and PGE2

The Journal of Headache and Pain ◽

10.1186/s10194-021-01377-6 ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Mohammad Mozafarihashjin ◽

Mansoureh Togha ◽

Zeinab Ghorbani ◽

Abolfazl Farbod ◽

Pegah Rafiee ◽

...

Keyword(s):

Growth Factor ◽

Chronic Migraine ◽

Case Control Study ◽

Demographic Data ◽

Serum Levels ◽

Episodic Migraine ◽

Case Control ◽

Blood Levels ◽

Headache Frequency ◽

Control Study

Abstract Background Several inflammatory and vascular molecules, and neurotrophins have been suggested to have a possible role in the development of migraine. However, pathophysiological events leading to migraine onset and transformation of episodic migraine (EM) to chronic migraine (CM) are not fully understood. Thus, we aimed to assess peripheral levels of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and prostaglandin E2 (PGE2) in EM and CM patients, and controls. Methods From September 2017 to June 2020, 89 subjects were enrolled in a case-control study; 23 and 36 EM and CM patients, respectively, and 30 age and sex-matched controls. Demographic data and medical history were obtained from all patients. Headache characteristics were recorded at baseline visit and ensuing 30 days for persons with migraine disease. Serum levels of NGF, BDNF, VEGF, and PGE2 were measured once for controls and EM and CM patients, and adjusted for age, sex, and body mass index. Results Serum levels of NGF were significantly lower in EM patients compared to controls and CM patients (P-value=0.003 and 0.042, respectively). Serum levels of BDNF were significantly lower in EM and CM patients as opposed to controls (P-value<0.001), but comparable between EM and CM patients (P-value=0.715). Peripheral blood levels of VEGF were significantly higher in EM and CM patients as opposed to controls (P-value<0.001), but not different between EM and CM patients (P-value=0.859). Serum levels of PGE2 were significantly lower in EM patients compared to controls (P-value=0.011), however similar between EM and CM patients (P-value=0.086). In migraine patients, serum levels of NGF and PGE2 positively correlated with headache frequency (NGF: ρ = 0.476 and P-value<0.001; PGE2: ρ = 0.286 and P-value=0.028), while corresponding levels of BDNF and VEGF did not correlate with headache frequency (BDNF: ρ = 0.037 and P-value=0.778; VEGF: ρ= -0.025 and P-value=0.850). Conclusions Our findings suggest that NGF, BDNF, PGE2, and VEGF may play a significant role in migraine pathogenesis and/or chronification, and therefore might bear potential value for novel targeted abortive and prophylactic migraine therapy. Further prospective cohort studies with larger sample sizes can more robustly evaluate the implications of these findings.

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Disability, burden, and symptoms related to sensitization in migraine patients associate with headache frequency

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0050 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Stefano Di Antonio ◽

Matteo Castaldo ◽

Marta Ponzano ◽

Francesca Bovis ◽

Paola Torelli ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Migraine ◽

High Frequency ◽

Low Frequency ◽

Episodic Migraine ◽

Headache Frequency ◽

Headache Attack ◽

Burden Of Headache ◽

The Difference

Abstract Objectives This observational study aimed to assess the difference in disability, burden, and sensitization between migraine patients with low-frequency headache attack (1–8 headache days/month), high-frequency headache attack (9–14 headache days/months), and patients with chronic migraine (>14 headache days/months). Methods Migraine patients with or without aura were divided into three groups according to headache frequency (low-frequency episodic migraine; high-frequency episodic migraine; chronic migraine). Questionnaires were used to assess the burden of headache, quality of life, phycological burden, and symptoms related to sensitization (estimated by the Central Sensitization Inventory). Differences among migraine groups were assessed using Chi-Quadro test, ANOVA, or Kruskal–Wallis as appropriate. Results 136 patients were included (68 low-frequency episodic migraine, 45 high-frequency episodic migraine, 23 chronic migraine). Patients with high frequency episodic migraine and chronic migraine differed from patients with low frequency episodic migraine showing a worse burden of headache (p=0.002; p=0.002), worse level of physical (p=0.001; p<0.001) and mental (p=0.002; p=0.001) quality of life, worse level of depression (p=0.008; p=0.003), and increase presence of symptoms related to sensitization (p<0.001; p=0.003). No differences were found in any variables between patients with high-frequency episodic migraine and patients with chronic migraine (p>0.05). Conclusions Patients with high-frequency episodic migraine and chronic migraine could be considered in the same segment of the migraine population, with similar degrees of disability and sensitization related symptoms.

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Mechanical punctate pain threshold is associated with headache frequency and phase in patients with migraine

Cephalalgia ◽

10.1177/0333102420925540 ◽

2020 ◽

Vol 40 (9) ◽

pp. 990-997

Author(s):

Li-Ling Hope Pan ◽

Yen-Feng Wang ◽

Kuan-Lin Lai ◽

Wei-Ta Chen ◽

Shih-Pin Chen ◽

...

Keyword(s):

Chronic Migraine ◽

Quantitative Sensory Testing ◽

Pain Threshold ◽

Episodic Migraine ◽

Headache Frequency ◽

Healthy Controls ◽

Sensory Testing ◽

Dynamic Changes ◽

Cold Pain ◽

Pain Thresholds

Objective Previous studies regarding the quantitative sensory testing are inconsistent in migraine. We hypothesized that the quantitative sensory testing results were influenced by headache frequency or migraine phase. Methods This study recruited chronic and episodic migraine patients as well as healthy controls. Participants underwent quantitative sensory testing, including heat, cold, and mechanical punctate pain thresholds at the supraorbital area (V1 dermatome) and the forearm (T1 dermatome). Prospective headache diaries were used for headache frequency and migraine phase when quantitative sensory testing was performed. Results Twenty-eight chronic migraine, 64 episodic migraine and 32 healthy controls completed the study. Significant higher mechanical punctate pain thresholds were found in episodic migraine but not chronic migraine when compared with healthy controls. The mechanical punctate pain thresholds decreased as headache frequency increased then nadired. In episodic migraine, mechanical punctate pain thresholds were highest ( p < 0.05) in those in the interictal phase and declined when approaching the ictal phase in both V1 and T1 dermatomes. Linear regression analyses showed that in those with episodic migraine, headache frequency and phase were independently associated with mechanical punctate pain thresholds and accounted for 29.7% and 38.9% of the variance in V1 ( p = 0.003) and T1 ( p < 0.001) respectively. Of note, unlike mechanical punctate pain thresholds, our study did not demonstrate similar findings for heat pain thresholds and cold pain thresholds in migraine. Conclusion Our study provides new insights into the dynamic changes of quantitative sensory testing, especially mechanical punctate pain thresholds in patients with migraine. Mechanical punctate pain thresholds vary depending on headache frequency and migraine phase, providing an explanation for the inconsistency across studies.

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The impact of chronic migraine: The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study methods and baseline results

Cephalalgia ◽

10.1177/0333102414552532 ◽

2014 ◽

Vol 35 (7) ◽

pp. 563-578 ◽

Cited By ~ 96

Author(s):

Aubrey Manack Adams ◽

Daniel Serrano ◽

Dawn C Buse ◽

Michael L Reed ◽

Valerie Marske ◽

...

Keyword(s):

Chronic Migraine ◽

Episodic Migraine ◽

Family Burden ◽

Headache Frequency ◽

Cross Sectional ◽

The Core ◽

Related Quality ◽

Health Related ◽

One Year ◽

The Impact

Background Longitudinal migraine studies have rarely assessed headache frequency and disability variation over a year. Methods The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study is a cross-sectional and longitudinal Internet study designed to characterize the course of episodic migraine (EM) and chronic migraine (CM). Participants were recruited from a Web-panel using quota sampling in an attempt to obtain a sample demographically similar to the US population. Participants who passed the screener were assessed every three months with the Core (baseline, six, and 12 months) and Snapshot (months three and nine) modules, which assessed headache frequency, headache-related disability, treatments, and treatment satisfaction. The Core also assessed resource use, health-related quality of life, and other features. One-time cross-sectional modules measured family burden, barriers to medical care, and comorbidities/endophenotypes. Results Of 489,537 invitees, we obtained 58,418 (11.9%) usable returns including 16,789 individuals who met ICHD-3 beta migraine criteria (EM (<15 headache days/mo): n = 15,313 (91.2%); CM (≥15 headache days/mo): n = 1476 (8.8%)). At baseline, all qualified respondents ( n = 16,789) completed the Screener, Core, and Barriers to Care modules. Subsequent modules showed some attrition (Comorbidities/Endophenotypes, n = 12,810; Family Burden (Proband), n = 13,064; Family Burden (Partner), n = 4022; Family Burden (Child), n = 2140; Snapshot (three months), n = 9741; Core (six months), n = 7517; Snapshot (nine months), n = 6362; Core (12 months), n = 5915). A total of 3513 respondents (21.0%) completed all modules, and 3626 (EM: n = 3303 (21.6%); CM: n = 323 (21.9%)) completed all longitudinal assessments. Conclusions The CaMEO Study provides cross-sectional and longitudinal data that will contribute to our understanding of the course of migraine over one year and quantify variations in headache frequency, headache-related disability, comorbidities, treatments, and familial impact.

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Interictal Metabolic Changes in Episodic Migraine: A Voxel-Based FDG-PET Study

Cephalalgia ◽

10.1111/j.1468-2982.2009.01890.x ◽

2009 ◽

Vol 30 (1) ◽

pp. 53-61 ◽

Cited By ~ 58

Author(s):

JH Kim ◽

S Kim ◽

S-I Suh ◽

S-B Koh ◽

K-W Park ◽

...

Keyword(s):

Small Volume ◽

Disease Duration ◽

Statistical Parametric Mapping ◽

Cingulate Cortex ◽

Episodic Migraine ◽

Metabolic Changes ◽

Anterior Cingulate ◽

Central Pain ◽

Headache Frequency ◽

Correlation Analyses

Whereas there are many H215O-positron emission tomography (PET) studies demonstrating neuronal activation during acute migraine attacks, little information is available on the interictal (headache-free period) glucose metabolic changes in migraine. We therefore conducted voxel-based statistical parametric mapping analysis of 18F-fluorodeoxyglucose-PET to evaluate interictal metabolic differences between 20 episodic migraine patients (four with aura; three men; mean age 34.0 ± 6.4 years) and 20 control subjects. Separate correlation analyses were performed to delineate a possible relationship between regional glucose metabolism and disease duration or lifetime headache frequency in migraine patients. Group comparison showed that migraine patients had significant hypometabolism in several regions known to be involved in central pain processing, such as bilateral insula, bilateral anterior and posterior cingulate cortex, left premotor and prefrontal cortex, and left primary somatosensory cortex (uncorrected P < 0.001, corrected P < 0.05 with small volume corrections). Correlation analyses showed that regional metabolism of the insula and anterior cingulate cortex had significant negative correlations with disease duration and lifetime headache frequency (uncorrected P < 0.001, corrected P < 0.05 with small volume corrections). Our findings of progressive glucose hypometabolism in relation to increasing disease duration and increasing headache frequency suggest that repeated migraine attacks over time lead to metabolic abnormalities of selective brain regions belonging to the central pain matrix.

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Topiramate: A Case Series Study in Migraine Prophylaxis

Cephalalgia ◽

10.1046/j.1468-2982.2002.00380.x ◽

2002 ◽

Vol 22 (8) ◽

pp. 659-663 ◽

Cited By ~ 29

Author(s):

WB Young ◽

MM Hopkins ◽

AL Shechter ◽

SD Silberstein

Keyword(s):

Chronic Migraine ◽

Case Series ◽

Total Body Weight ◽

Episodic Migraine ◽

Headache Frequency ◽

Transformed Migraine ◽

Cognitive Difficulties ◽

Headache Severity ◽

Case Series Study ◽

Total Body

We reviewed the electronic records of 74 migraine patients treated with topiramate for more than 6 weeks. Twenty-four patients had episodic migraine and 50 had chronic (transformed) migraine. Most (81%) started treatment at 25 mg per day and reached a dose of 100 mg twice a day (mean dose on the last follow-up visit was 208 mg). The mean headache frequency decreased from 20.6 days to 13.6 days per month ( P < 0.0001) for all headaches (9.9-5.1 ( P < 0.0001) and 25.7-17.7 ( P < 0.001) for episodic migraine and chronic migraine, respectively). The percentage of patients whose headache frequency was reduced by ≥ 50% was 44.6% for all patients; 58.3 for episodic migraine and 38.0 for chronic migraine. For all patients mean headache severity (10-point scale) was reduced from 6.2 to 4.8 ( P < 0.0001). Patients on monotherapy (20%) and polytherapy (80%) had similar reductions in headache frequency. Adverse events were usually mild to moderate and were seen in 58.1% (paresthesias in 25%, cognitive difficulties 14.9%). Mean weight loss was 3.1 ± 4 kg (3.8% of total body weight).

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