Similar treatment needs for high-frequency episodic and low-frequency chronic migraine

Data from the web-based CaMEO study indicate substantial overlap in the measures of burden and depression among respondents with high-frequency episodic migraine (8-14 monthly headache days (MHDs)) and those with low-frequency chronic migraine (15-23 MHDs). These findings suggest that the treatment needs of these 2 patient categories may be similar, suggesting that the 15-MHD threshold currently used for diagnosis of chronic migraine may merit reconsideration [1].

The 3^rd edition of the International Classification of Headache Disorders (ICHD-3) defines chronic migraine as the occurrence of ≥15 MHDs for ≥3 months with criteria for migraine met on ≥8 days per month. Patients with <15 MHDs are considered to have episodic migraine. However, differences in migraine burden between patients with high-frequency episodic migraine and low-frequency chronic migraine have not been well characterised.

The CaMEO study was a longitudinal, web-based study that used quota sampling to identify respondents who met modified ICHD-3 migraine criteria. Data was provided by almost 17,000 respondents. Based on self-reported MHDs, 4 subgroups were defined:

• low- and moderate-frequency episodic migraine (0-7 MHDs);
• high-frequency episodic migraine (8-14 MHDs);
• low-frequency chronic migraine (15-23 MHDs); and
• high-frequency chronic migraine (≥24 MHDs).

The percentages of patients with severe disability (grade 4) or at least moderate disability (grade 3 or 4) based on the Migraine Disability Assessment Scale (MIDAS) were assessed in the 4 MHD subgroups, as well as severe (≥5) or moderate-to-severe scores (≥3) on the Migraine Interictal Burden Scale (MIBS) (see Table). Furthermore, the percentages of patients with moderate-to-severe depression –a score of ≥10 on the 9-item Patient Health Questionnaire– and moderate-to-severe anxiety  –a score of ≥10 on the 7-item Generalised Anxiety Disorder scale– were assessed. All changes were statistically significant for the linear-by-linear association test (P<0.001).

Interestingly, substantial overlap between respondents with high-frequency episodic migraine and low-frequency chronic migraine was found for levels of moderate-to-severe disability, interictal burden, and depression.

Healthcare resource utilisation significantly increased across MHD categories (P<0.001), but was markedly similar between respondents with high-frequency episodic migraine and low-frequency chronic migraine. Similar findings were observed concerning utilisation of acute and preventive treatments. However, the rate of medication overuse was more than 20% higher among those with low-frequency chronic migraine versus high-frequency episodic migraine.

Consistent with prior research, this analysis demonstrated a strong linear relationship between MHD frequency and measures of migraine disease burden and healthcare resource utilisation, showing increases in all measures among patients with high-frequency episodic migraine compared with low-frequency chronic migraine.

 

1. Lipton RB. Exploring the boundaries between episodic and chronic migraine: results from the CaMEO study. MTIS 2020 Virtual Symposium, abstract MTV20-DP-009.

Posted on 27 October 202017 May 2024