People who have episodic migraine that is not adequately treated are three times more likely to progress to chronic migraine than those who have an effective treatment for episodic migraine, according to a recent study. In Keep Episodic Migraine From Progressing to Chronic on Migraine.com, I beg everyone with episodic migraine to see a doctor and also dispel some myths and misunderstandings about migraine treatment. Episodic migraine is bad enough, but chronic migraine is hell. If you have episodic migraine that’s not well-managed, please, please seek better treatment — no one should have to live with the misery of chronic migraine.
What I don’t mention in that Migraine.com post is how close the topic is to my own heart. My 16-year-old niece has had chronic daily headache since she was 11 and has episodic migraine attacks all her life, which have gotten more frequent as she’s gotten older. Whenever I see news about episodic migraine progressing to chronic — or chronic migraine worsening over time — I wonder how my niece’s migraine will progress. Everything I know about this illness points to the likelihood of her symptoms worsening without effective intervention. The thought breaks my heart.
Imagining my bright, driven, kind niece as sick as I have been makes me weep. I’m hopeful that her early diagnosis and the advances of migraine treatment in the last 20 years will mean she never has to endure what I have. I’d like my experience to be a cautionary tale that leads her and her parents to treat her migraines aggressively before they spiral out of control and become even harder to corral. There’s no guarantee her migraine trajectory will be the same as mine, but there’s also no guarantee it won’t. I’m afraid the odds aren’t in her favor.
Long-term Prognosis of Migraine Favorable is the headline on a Reuters story from yesterday. Before you rejoice, know that the outlook is good for people with episodic headache or migraine, but far from rosy for chronics (like me and like many of you).
The 549 patients that participated in the study had an initial evaluation in 1989 and a follow-up evaluation in 2001. At the start of the study, 64 participants had migraines, 146 had frequent episodic tension-type headaches, and 15 had chronic tension-type headache.
In 2001, 42% of those with migraine had experienced remission, 38% had 1-14 migraines a year, and the remainder had at least 15 migraines per year. In participants with tension-type headache, 45% had 0-14 headache days per year, 40% had 15-179 headache days per year, and 16% had at least 180 headache days each year.
According to the Reuters article, “predictors of a poor outcome included chronic tension-type headache at the first evaluation, coexisting migraine, not being married and sleep problems.” (I’m quite curious about how marriage fits into the equation.)
It’s great to have some longitudinal research of headache. Gathering long-term data is extraordinarily difficult, especially in a field that’s ever-changing and has patients with experiences that are readily quantifiable. So I do appreciate the work of the study, but I’d like to know how the current understanding of migraine as a neurological disease fits into the findings. I’m also curious about why the groups were broken down in this manner and some data points that weren’t reported by Reuters. Here are some of the questions racing through my mind.
- Were migraine patients who were in remission simply without headache or were they migraine-free because they used effective abortives that weren’t available in 1989? (Imitrex, the first triptan, came on the market in 1993.)
- Is headache the only migraine symptom that was studied?
- Are any of the patients taking preventives? If so, which ones? Do patients on preventives have fewer, more or the same frequency of headache before?
- How many headache days per year did patients have in the initial evaluation? Were patients with a high number of headache days in 1989 more likely to still have frequent headache days?
- How are participants in the 15-179 headache days category distributed? Are most at the low end or in the middle? And how can the span be so wide? As a patient, there seems a significant difference between 15, 85 and 179 headache days per year.
- Self-reports from people with headache are notoriously unreliable. Sure, we can all use a 1-10 scale, but that’s subjective. A headache that I’d call a 6 today may have been an 9 last year, or one that was a 4 may now be a 2.
- Headache classifications have changed significantly in the years between 1989 and 2001. Were the same classifications used? If not, how were they modified?
Visiting the local med school library would probably answer some these questions, but I haven’t the energy for that. I’ll stay in the dark for now. If you’d like to do the honors, PubMed has two citations of journal articles with the study’s data.