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Abstract
Objective: To test the hypothesis that ineffective acute treatment of episodic migraine (EM) is associated with an increased risk for the subsequent onset of chronic migraine (CM).
Methods: In the American Migraine Prevalence and Prevention Study, respondents with EM in 2006 who completed the Migraine Treatment Optimization Questionnaire (mTOQ-4) and provided outcome data in 2007 were eligible for analyses. The mTOQ-4 is a validated questionnaire that assesses treatment efficacy based on 4 aspects of response to acute treatment. Total mTOQ-4 scores were used to define categories of acute treatment response: very poor, poor, moderate, and maximum treatment efficacy. Logistic regression models were used to examine the dichotomous outcome of transition from EM in 2006 to CM in 2007 as a function of mTOQ-4 category, adjusting for covariates.
Results: Among 5,681 eligible study respondents with EM in 2006, 3.1% progressed to CM in 2007. Only 1.9% of the group with maximum treatment efficacy developed CM. Rates of new-onset CM increased in the moderate treatment efficacy (2.7%), poor treatment efficacy (4.4%), and very poor treatment efficacy (6.8%) groups. In the fully adjusted model, the very poor treatment efficacy group had a more than 2-fold increased risk of new-onset CM (odds ratio = 2.55, 95% confidence interval 1.42–4.61) compared to the maximum treatment efficacy group.
Conclusion: Inadequate acute treatment efficacy was associated with an increased risk of new-onset CM over the course of 1 year. Improving acute treatment outcomes might prevent new-onset CM, although reverse causality cannot be excluded.
GLOSSARY
- AMPP=
- American Migraine Prevalence and Prevention;
- ASC-12=
- Allodynia Symptom Checklist–12;
- CI=
- confidence interval;
- CM=
- chronic migraine;
- DSM-IV=
- Diagnostic and Statistical Manual of Mental Disorders, 4th edition;
- EM=
- episodic migraine;
- ICHD-2=
- International Classification of Headache Disorders, 2nd edition;
- MIDAS=
- Migraine Disability Assessment Scale;
- mTOQ-4=
- Migraine Treatment Optimization Questionnaire;
- NSAID=
- nonsteroidal anti-inflammatory drug;
- OR=
- odds ratio;
- PHQ-9=
- Patient Health Questionnaire–depression module
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 641
Supplemental data at Neurology.org
- Received March 28, 2014.
- Accepted in final form October 13, 2014.
- © 2015 American Academy of Neurology
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