Exploring the Boundaries Between Episodic and Chronic Migraine: Results from the CaMEO Study

Richard B. Lipton, MD

AHSAM 2020 - Oral session
Published on October 2, 2020 | NEW

5 minute listen

7 minute read

Key messages

  • Migraine is a chronic neurologic disease characterized by headache pain with nausea and sensory sensitivity in various combinations.
  • There was a strong linear relationship between monthly headache day frequency and measures of migraine burden and healthcare resource utilization, showing increases in all measures among high-frequency episodic migraine (HFEM) respondents compared to low-frequency chronic migraine (LFCM).
  • Results showed substantial overlap in levels of burden, anxiety, depression and healthcare utilization among HFEM and LFCM.
  • Treatment needs of HFEM and LFCM may be similar.
  • The 15-monthly headache day threshold used for the diagnosis of chronic migraine may merit reconsideration.
  • Background

    What do we already know about this topic?
  • Findings

    What does this study add?
  • Perspectives

    How does this study impact clinical practice?
  • Expert commentary

    by Thomas N. Ward, MD

Key messages

  • Migraine is a chronic neurologic disease characterized by headache pain with nausea and sensory sensitivity in various combinations.
  • There was a strong linear relationship between monthly headache day frequency and measures of migraine burden and healthcare resource utilization, showing increases in all measures among high-frequency episodic migraine (HFEM) respondents compared to low-frequency chronic migraine (LFCM).
  • Results showed substantial overlap in levels of burden, anxiety, depression and healthcare utilization among HFEM and LFCM.
  • Treatment needs of HFEM and LFCM may be similar.
  • The 15-monthly headache day threshold used for the diagnosis of chronic migraine may merit reconsideration.

Background

What do we already know about this topic?

  • The International Classification of Headache Disorders, 3rd edition (ICHD-3), defines chronic migraine as 15 or more monthly headache days for ≥3 months with criteria for migraine, with or without aura, met on ≥8 days per month.1
  • Episodic migraine is migraine with fewer than 15 monthly headache days.
  • Differences in the burden of migraine among people with various headache frequencies have not been well characterized.

How was this study conducted?

  • The CaMEO Study was a longitudinal, web-based study of adults (aged 26–57 years) meeting modified ICHD-3 migraine criteria (N=16,789).2
  • Data was subgrouped based upon self-reported monthly headache days: Low-and moderate-frequency episodic migraine (LFEM), HFEM, LFCM, and high-frequency chronic migraine (HFCM).
  • The relationships of monthly headache day category with various outcome measures, such as headache-related disability, characteristics and medication, were assessed by chi-test for trend.

Findings

What does this study add?

  • The more frequent headache categories were associated with a slightly older age of onset, higher proportion of BMI in the obese range, overall lower level of household income and education.
  • There was overlap between HFEM and LFCM respondents in levels of cutaneous allodynia, disability, interictal burden, anxiety and depression.
  • Utilization of healthcare resources significantly increased across monthly headache day categories (p<0.001) but were markedly similar between HFEM and LFCM.
  • Utilization of acute and preventative treatments increased with monthly headache day category, but patterns of treatment utilization were generally similar between HFEM and LFCM.
  • Compared to HFEM, the rate of medication overuse was more than 20 percentage points higher among LFCM.

Perspectives

How does this study impact clinical practice?

  • Treatment needs of HFEM and LFCM may be similar.
  • The 15-monthly headache day threshold used for the diagnosis of chronic migraine may merit reconsideration.
  • LFCM patients may overuse medication.

Perspectives

How does this study impact clinical practice?

  • Treatment needs of HFEM and LFCM may be similar.
  • The 15-monthly headache day threshold used for the diagnosis of chronic migraine may merit reconsideration.
  • LFCM patients may overuse medication.

This is a highlights summary of an oral session given at the AHSAM 2020 Virtual Annual Scientific Meeting and presented by:

Richard B. Lipton, MD
Professor and Vice Chair of Neurology
Albert Einstein College of Medicine
Bronx, New York

The content is produced by Infomedica, the official reporting partner of ASHAM 2020 Virtual Annual Scientific Meeting. The summary text was drafted by Goldcrest Medical Writing, reviewed by Marco Vercellino, MD, an independent external expert, and approved by Jessica Ailani, MD, FAHS and Mark J. Burish, MD, PhD, the scientific editors of the program.

The presenting authors of the original session had no part in the creation of this conference highlights summary.

In addition, an expert commentary on the topic has been provided by:

Thomas N. Ward, MD
Geisel School of Medicine at Dartmouth

Thomas N. Ward, MD
Geisel School of Medicine at Dartmouth

Dr. Thomas N. Ward grew up in Portsmouth, NH where he attended the public school system. He graduated from Dartmouth College cum laude in 1975 and from Dartmouth Medical School with honors in 1980 and was elected a member of AOA.

He was an intern and resident in Internal Medicine at Albany Medical Center from 1980-1982 then a resident in Neurology from 1982-1985 at Dartmouth-Hitchcock Medical Center. Subsequently he practiced Neurology at Laconia Clinic in Laconia, NH until returning to Dartmouth-Hitchcock Medical Center in 1989 where he founded their headache clinic.

Dr. Ward is a Fellow of the American Headache Society and of the American Academy of Neurology as well as the American Neurological Association. He is President of the Headache Cooperative of New England and certified in the subspecialty of Headache Medicine by the United Council for Neurologic Subspecialties. He is an Active Emeritus Professor of Neurology at the Geisel School of Medicine at Dartmouth. He was the Editor in Chief of the journal Headache: the journal of head and face pain from 2013-2020. He currently sees patients at the White River Junction, VA Hospital

1. Headache Classification Committee of the International Headache Society (IHS) The    International Classification of Headache Disorders. Cephalalgia 2018;38:1-211.

2. Adams AM, Serrano D, Buse DC, et al. The impact of chronic migraine: The Chronic Migraine   Epidemiology and Outcomes (CaMEO) Study methods and baseline results. Cephalalgia 2015;35:563-578.



Headache
Chronic Migraine


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