The Course of Frequent Episodic Migraine in a Large Headache Clinic Population: A 12-year Retrospective Follow-up Study

Carl G. H. Dahlöf, MD, PhD; Maria Johansson, PhD; Susanne Casserstedt, PhD; Tina Motallebzadeh, PhD

Disclosures

Headache. 2009;49(8):1144-1152. 

In This Article

Results

In total, 517 subjects were randomly selected from the eligible patients in the Migraine File and were first contacted by mail. Of these, 38 were not willing to participate, and 105 were lost to follow up. Our goal to enroll 40 women and 40 men from each group of age of onset was fulfilled in all but one case; there were only enough men in GMC's database to complete the interview with 14 men who reported their migraine onset between ages 40 and 49. Altogether, 374 subjects (200 women and 174 men) completed the interview. As time to follow up was calculated according to the patient's first GMC visit (a period extending from 1991 to December 31, 1996), time to follow up ranged from 9 to 15 years, with an average of 12.6 years (median: 12 years).

Of the 374 interviewed subjects, 110 (29.4%). migraine were free of attacks; this group henceforth will be referred to as past migraineurs. On average, the past migraineurs had been free from migraine attacks for 7.2 years (median: 7 years). Two individuals stated that their migraine had ceased the same year that the interview was conducted. Ninety-one percent of the past migraineurs had not experienced a migraine attack for 2 years or more. Of the remaining 264 subjects who reported still having migraine, 6 subjects (1.6%) reported ≥15 attack days per month. Baseline demographic information regarding persistent and past migraineurs is shown in Table 1.

Thirty percent of all men and 29% of all women had become migraine-free. Generally speaking, the earlier the onset of migraine, the lower the likelihood that one was migraine-free (Table 2). Among women who had their migraine onset at age 40–49, half had become migraine-free. The trend in men was not as evident. The average duration of active migraine for past migraineurs was 25 years for both men and women (median = 23 years for both genders).

Heredity

A positive family history of migraine (grandparents, parents, siblings, and/or children) was present in 74% of female persistent migraineurs and 58% of female past migraineurs (P = .023). In there was no such difference recorded; 69% of male persistent migraineurs had a positive family history, compared with 67% of male past migraineurs.

Age

Average ages were significantly higher in past migraineurs than persistent migraineurs. Some 12.5% of persistent migraineurs and 23.6% of past migraineurs were 55 or older at baseline (P < .01).

Heart Rate and Blood Pressure

No significant differences in average heart rates at baseline were observed. Baseline systolic and diastolic blood pressures were higher in past migraineurs (132.3–138.4 mmHg compared with 127.3–131.1 mmHg and 80.8–85.1 mmHg, compared with 78.0–80.5 mmHg, respectively). Twenty percent of persistent migraineurs and 34% of past migraineurs had a diastolic blood pressure over 90 mmHg at baseline (P ≤ .01).

Smoking Habits

No differences were seen among women, where 20% of both persistent and past migraineurs were smokers at baseline. In men, however, 20% of persistent migraineurs and 38% of past migraineurs were smokers at baseline (P = .022) (n = 128/50 and 105/45, respectively). No data were available regarding the total duration of smoking history nor persistence vs cessation of smoking at the time when migraine attacks ceased.

Alcohol Consumption

The 2 groups did not differ according to rates and degree of alcohol use.

Head Trauma

Among the female population, 23% of persistent migraineurs and 36% of past migraineurs had experienced a head injury causing mild or moderately severe brain concussion (P = .28). In males, 46% of persistent migraineurs and 41% of past migraineurs remembered suffering similar head trauma (N = 52/22/52/17). Valid response rates were only obtained in 39% and 35% of the persistent migraineurs and past migraineurs, respectively.

Migraine with Aura

In women, 33% of the persistent migraineurs had migraine with aura, compared with 19% of the past migraineurs (P = .038). Twenty-six percent of male migraineurs, both past and persistent, had migraine with aura (n = 143/57 and 121/53, respectively).

Headache: Pulsatile vs Non-pulsatile

In women, 80% of persistent migraineurs and 71% of past migraineurs characterized their typical headache as pulsatile (P = NS). In men, 82% of persistent migraineurs and 69% of past migraineurs reported their headaches were pulsatile (P = .019).

Number of Attacks per Month

The distribution of average, median, standard deviation, and confidence intervals between past and persistent migraineurs for migraine attack frequency at baseline is presented in Table 3. The confidence intervals suggest a tendency toward a higher frequency of attacks among males with persistent migraine. Among persistent migraineurs, 16% had fewer than 2 attacks per month at baseline, compared with 32% in past migraineurs (P = .023).

Trigger Factors

All baseline data regarding migraine attack triggers are summarized in Table 4. For alcohol, a statistical analysis was made for men and women separately as well as for the study population as a whole. For men, alcohol as a less frequently reported trigger was associated with remission of migraine (P < .01). A trend in the same direction was found in women but was not statistically significant (P = .084). For the entire population, the association between alcohol as a less frequently reported trigger factor and remission of migraine was significant at P < .001. Odor as a frequently reported trigger appeared to correlate with migraine remission in men (P < .001) whereas the opposite was seen in women (P < .058).

Associated Symptoms

Table 5 summarizes the comparison of migraine-associated symptoms at baseline for the 2 groups (ie, past vs persistent migraineurs). In men, nausea and osmophobia correlated with migraine persistence (P = .026 and P = .032, respectively), and in women the only clinically significant difference involved aggravation of headache consequent to physical activity (P = .020).

Over the follow-up period, subjects with persistent migraine continued to experience impaired quality of life consequent to the disorder. Related data are presented in Table 6.

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