This is for our pain providers.
Authors: Lipton RB et al., Neurology 2015 Jan 21;
Ineffective acute treatment is associated with progression from episodic to chronic migraine, but a causal relationship cannot be assumed.
Using population-based data from the American Migraine Prevalence and Prevention Study, the authors examined whether efficacy of acute migraine treatment predicted progression from episodic to chronic migraine during a 1-year period. The authors measured acute treatment efficacy using a validated questionnaire and categorized efficacy as very poor, poor, moderate, or maximum. They used regression analysis to adjust for age, sex, household income, headache frequency and disability, and acute medication class.
Of 5681 episodic migraineurs, 174 (3.1%) experienced progression to chronic migraine. Worse acute treatment efficacy was associated with higher rates of new-onset chronic migraine: 1.9%, 2.7%, 4.4%, and 6.8% in the maximum, moderate, poor, and very poor treatment efficacy groups, respectively. Worse acute treatment efficacy was also associated with lower household income and with higher headache frequency and disability. In a fully adjusted model, chronic migraine onset was significantly associated with very poor treatment efficacy (odds ratio, 2.55; 95% confidence interval, 1.42–4.61) and poor efficacy (OR, 1.69; 95% CI, 1.02–2.81).
Poor efficacy of acute migraine treatment is associated with chronic migraine onset, raising the interesting question of whether providers can intervene to modify disease progression. A causal relationship is possible, but an observational study cannot distinguish between alternative explanations, including that poor response to acute medications and progression to chronic migraine are both related to more severe underlying disease. In addition, worse acute response was associated with lower household income, which might be associated with poor migraine care in general — for example, decreased use of preventive medications. Use of preventives was not examined as a covariate in this study. Regardless, we should strive for the most effective acute treatment of migraine in all our patients.