TY - JOUR
T1 - Rates, predictors, and consequences of remission from chronic migraine to episodic migraine
AU - Manack, A.
AU - Buse, D. C.
AU - Serrano, D.
AU - Turkel, C. C.
AU - Lipton, R. B.
N1 - Funding Information:
Dr. Manack is a full-time employee of Allergan, Inc., in which she holds stock/stock options. Dr. Buse serves on scientific advisory boards for Iroko Pharmaceuticals and MAP Pharmaceuticals, Inc.; and has received honoraria from Allergan, Inc., Merck Serono, and Endo Pharmaceuticals. Dr. Serrano reports no disclosures. Dr. Turkel is a full-time employee of Allergan, Inc., in which she holds stock/stock options. Dr. Lipton serves/has served on scientific advisory boards for and received funding for travel from Bayer Schering Pharma, Merck Serono, GlaxoSmithKline, Endo Pharmaceuticals, Kowa Pharmaceuticals America, Inc., Allergan, Inc., Neuralieve Inc., Ortho-McNeil-Janssen Pharmaceuticals, Inc.; has received funding for travel from the American Headache Society and the Diamond Headache Center; serves as Associate Editor of Cephalalgia and on the editorial boards of Neurology ® and Headache ; receives royalties from publishing Headache in Clinical Practice (Isis Medical Media, 2002), Headache in Primary Care (Isis Medical Media, 1999), Wolff's Headache (Oxford University Press, 2001, 2008), Managing Migraine: A Physician's Guide (BC Decker, 2008), and Managing Migraine: A Patient's Guide (BC Decker, 2008); has received speaker honoraria from the National Headache Foundation, the University of Oklahoma, the American Academy of Neurology, the Annenberg Foundation, Merck Serono, GlaxoSmithKline, and Coherex Medical; receives research support from the American Headache Society, National Headache Foundation, the Migraine Research Foundation, and the NIH; and holds stock options in Minster Pharmaceuticals plc.
PY - 2011/2/22
Y1 - 2011/2/22
N2 - OBJECTIVES: This study has 3 objectives: 1) to estimate remission rates in a population-based sample of subjects with chronic migraine (CM); 2) to identify potential predictors of CM remission; and 3) to assess the influence of CM remission on headache-related disability. METHODS: The American Migraine Prevalence and Prevention study is a prospective, population-based, mailed questionnaire survey, which included questions regarding headache frequency, symptomatology, demographics, comorbidities, health care utilization, and headache-related disability. Three years of longitudinal data were analyzed to determine rates of CM remission and assess predictors of remission using logistical regression models. The consequence of remission was measured by changes in disability, as measured by the Migraine Disability Assessment, over time. RESULTS: A total of 383 respondents had CM in 2005 and follow-up data in 2006 and 2007. Over 2 years, among those with CM at baseline, approximately 34% (n = 130) had persistent CM while 26% (n = 100) had remitted CM. In our final multivariate model, predictors of remission included baseline headache frequency (15-19 vs 25-31 headache days/month; odds ratio [OR] 0.29; 95% confidence interval [CI] 0.11 to 0.75) and absence of allodynia (OR 0.45; 95% CI 0.23 to 0.89). Preventive medication use was associated with lower remission rate (OR 0.41; 95% CI 0.23 to 0.75), but this effect lost significance when headache frequency was included. Over 2 years, those with persistent CM demonstrated increased disability while those with remitted CM demonstrated decreased disability. CONCLUSIONS: These findings have clinical practice implications, as it is important to consider that remission rates are variable. However, the benefit of remission goes beyond symptom reduction and may translate to marked decreases in headache-related disability.
AB - OBJECTIVES: This study has 3 objectives: 1) to estimate remission rates in a population-based sample of subjects with chronic migraine (CM); 2) to identify potential predictors of CM remission; and 3) to assess the influence of CM remission on headache-related disability. METHODS: The American Migraine Prevalence and Prevention study is a prospective, population-based, mailed questionnaire survey, which included questions regarding headache frequency, symptomatology, demographics, comorbidities, health care utilization, and headache-related disability. Three years of longitudinal data were analyzed to determine rates of CM remission and assess predictors of remission using logistical regression models. The consequence of remission was measured by changes in disability, as measured by the Migraine Disability Assessment, over time. RESULTS: A total of 383 respondents had CM in 2005 and follow-up data in 2006 and 2007. Over 2 years, among those with CM at baseline, approximately 34% (n = 130) had persistent CM while 26% (n = 100) had remitted CM. In our final multivariate model, predictors of remission included baseline headache frequency (15-19 vs 25-31 headache days/month; odds ratio [OR] 0.29; 95% confidence interval [CI] 0.11 to 0.75) and absence of allodynia (OR 0.45; 95% CI 0.23 to 0.89). Preventive medication use was associated with lower remission rate (OR 0.41; 95% CI 0.23 to 0.75), but this effect lost significance when headache frequency was included. Over 2 years, those with persistent CM demonstrated increased disability while those with remitted CM demonstrated decreased disability. CONCLUSIONS: These findings have clinical practice implications, as it is important to consider that remission rates are variable. However, the benefit of remission goes beyond symptom reduction and may translate to marked decreases in headache-related disability.
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U2 - 10.1212/WNL.0b013e31820d8af2
DO - 10.1212/WNL.0b013e31820d8af2
M3 - Article
C2 - 21270413
AN - SCOPUS:79952026321
SN - 0028-3878
VL - 76
SP - 711
EP - 718
JO - Neurology
JF - Neurology
IS - 8
ER -