New Study Sheds Light on Migraine Changes

June 19, 2007

Vicki Gerson

June 19, 2007 (Chicago) — A new Swedish study with 12-year follow-up of migraineurs suggests that migraine is not a progressive disorder in most patients. Results also indicate that many migraineurs report less frequent, shorter, and/or milder attacks over time.

The findings were presented here at the American Headache Society 49th Annual Scientific Meeting.

"The study proves this is not a progressive disorder and the improvement that migraineurs achieve is due to the treatment options available today," Carl Dahlöf, MD, PhD, headache clinic founder and professor of neurology at the Gothenburg Migraine Clinic, in Sweden, told the attendees here.

Natural History of Migraine

Despite the prevalence of migraine, relatively little is known about whether migraine is in fact progressive over time, the authors note in their abstract.

The current study was conducted at the Gothenburg Migraine Clinic. Here, 374 patients (200 women, 174 men) with an average age of 55.5 years, ranging in age from 19 to 87 years, were randomly selected from a total population of 2812 patients with episodic migraine (headache severity [HS] 1.1 and 1.2) and an attack frequency of 1 to 6 attacks per month.

Between 1994 and 2006, telephone interviews were conducted to evaluate any changing pattern of migraine. Investigators looked at whether any of the patients were symptom free, as well as the frequency, duration, and severity of migraine attacks among those with persistent migraine. Questions were also asked concerning any quality-of-life impairment, work absence, and patients' satisfaction with current treatment. The subjective benefits of early vs late treatment were also determined.

Over the 12-year period, migraine was found to have resolved in 110 (29%) of patients, 57 women and 53 men. Among the 264 patients who continued to experience migraine at 12-year follow-up, 80% reported a change in the frequency of migraine; most of these, 80%, reported a decrease in the number of attacks per month. In addition, 55% reported a change in duration of attacks, with 66% of these patients saying they experienced shorter attacks.

In terms of severity of attacks, 66% of migraineurs reported a change in pain intensity over time, with 84% of these patients reporting milder pain at 12-year follow-up.

In the overall group, only 6 subjects (1.6%) developed chronic migraine.

Although there was a changing migraine pattern, a significant number of migraineurs still suffered impairment on quality-of-life parameters such as decreased family or social functioning as well as work absences.

Most migraineurs indicated satisfaction with their current medication (78%), which could perhaps be attributed to the high use of triptans (62.5%), the authors note. Dr. Dahlöf attributed these results to the fact that this group of patients has been actively treated at a specialized migraine clinic over time.

A Benign Disease

"For the vast majority of migraine suffers, this is a benign disease," noted Randolph W. Evans, MD, clinical professor of neurology from Baylor College of Medicine, in Houston, Texas, who attended the presentation.

"Two important factors in this study indicate that [first], the frequency of attacks did not predict who would go into remission; and [second], that only 1.6% of the patients developed chronic migraines, and 0% of the chronic migraineurs had strokes," he told Medscape. "The study indicates that 29% of the migraines stopped, and that's my experience with the typical episodic migraine population."

Grants for this study were provided by Allergan, AstraZeneca, and Merck. The faculty received no compensation.

American Headache Society, Annual Scientific Meeting: Abstract 21. June 7-10, 2007


Vicki Gerson is a freelance writer for Medscape.