The impact on patients of increasing migraine frequency

The disease burden of migraine increases with headache frequency. This has significant impact on patients in terms of disability, headache impact, anxiety and depression, even in those with episodic migraine (EM) who not fulfil the criteria for chronic migraine (CM), and was the focus of a satellite symposium at the ENA2021 virtual congress.

Relationship between episodic and chronic migraine

Migraine is classically sub‑divided into EM (<15 headache days [HD]/month) and CM (≥15 HD/month for >3 months)1, depending on headache frequency, considered two different variations of the same disease state. In reality, migraine frequency exists on a spectrum, with one‑third having headache on ≥4 days/month, and 6% qualifying for the diagnosis of CM1.

If headache attacks increase in frequency episodic can transform into chronic migraine

Cristina Tassorelli (University of Pavia, Italy) explained the complex relationship between EM and CM. Patterns of treatment response can differ, suggesting the possibility of both distinct and overlapping biological mechanisms2. If headache attacks increase in frequency, EM can transform into CM over time3.

 

Cause of significant disability

Level of disability … increased with increasing headache frequency

Migraine is the second largest cause of disability worldwide4, especially in those <50 years, and EM, as well as CM, is associated with significant disability. The International Burden of Migraine Study (n=1821) showed that the level of disability, measured by Migraine Disability Assessment (MIDAS) score, increased with increasing headache frequency1. By 12 to 14 HD/month, approximately 50% of patients had ‘very severe’ disability and 30% ‘severe’, without meeting the criteria for CM. High frequency EM (HFEM; 10 to 14 HD/month) is associated with higher disability levels and greater headache impact than low frequency EM (1 to 9 HD/month), and worsening anxiety and depression5. With HFEM, mild, moderate and severe depression were seen in 36.3%, 10.9% and 1.5% of patients respectively.

 

Multidimensional disease

It is insufficient to treat the headache alone

Migraine is a multidimensional disease, and it is insufficient to treat the headache alone. A range of symptoms are associated with the various migraine stages, including light sensitivity, visual disturbances, and cognitive difficulties6. Migraine attacks may be triggered and aggravated by multiple factors, including hormonal fluctuations, flashing lights, and comorbidities such as obesity.

Worldwide, migraine is often under-diagnosed and under-treated, due to misdiagnosis and patients’ expectations of poor treatment outcomes7. More than two‑thirds of patients have either never consulted a physician or have stopped doing so8, and two‑thirds who qualify for preventive treatment do not receive it9.

 

Three pillars of treatment

Unlike many neurological diseases migraine is a treatable condition

Prof Tassorelli stressed that, unlike many neurological diseases, migraine is a treatable condition10, with the three pillars being:

  • Education
  • Acute treatment (specific and non-specific)
  • Preventive treatment (pharmacological and non-pharmacological)

 

Key is understanding the patient’s treatment goals

Matching the right treatment strategy to the right patient is crucial to successful management of migraine, and key is understanding the patient’s treatment goals. A diary or app can empower the patient in monitoring patterns of symptoms and response to treatment, and the multidisciplinary team can help manage triggers, aggravating factors, and comorbidities.

Educational financial support for this Satellite symposium was provided by Lundbeck.

 

 

 

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. Blumenfeld AM, et al. Disability, HRQoL and resource use among chronic and episodic migraineurs: results from the International Burden of Migraine Study (IBMS). Cephalalgia 2011;31(3):301-15.
  2. Katsarava Z, et al. Defining the differences between episodic migraine and chronic migraine. Curr Pain Headache Rep 2012;16(1):86-92.
  3. Bigal ME, Lipton RB. Clinical course in migraine: conceptualizing migraine transformation. Neurology 2008;71(11):848-55.
  4. GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018;17(11):954-76.
  5. Torres-Ferrús M, et al. When does chronic migraine strike? A clinical comparison of migraine according to the headache days suffered per month. Cephalalgia 2017;37(2):104-13.
  6. American Migraine Foundation. The timeline of a migraine attack. 2018. Available at: https://americanmigrainefoundation.org/resource-library/timeline-migraine-attack.
  7. Moriarty M, Mallick-Searle T. Diagnosis and treatment for chronic migraine. Nurse Pract 2016;41(6):18-32.
  8. Miller S, Matharu MS. Migraine is underdiagnosed and undertreated. Practitioner 2014;258(1774):19-24, 2-3.
  9. Diamond S, et al. Patterns of diagnosis and acute and preventive treatment for migraine in the United States: results from the American Migraine Prevalence and Prevention study. Headache 2007;47(3):355-63.
  10. American Headache Society. The American Headache Society Position Statement on integrating new migraine treatments into clinical practice. Headache 2019;59(1):1-18.
You are leaving Progress in Mind
Hello
Please confirm your email
We have just sent you an email, with a confirmation link.
Before you can gain full access - you need to confirm your email.
The information on this site is exclusively intented for health care professionals.
Congress
Register for access to Progress in Mind in your country