How Does Migraine Change After 10 Years? A Clinical Cohort Follow-Up Analysis

Headache. 2020 May;60(5):916-928. doi: 10.1111/head.13774. Epub 2020 Feb 18.

Abstract

Objective: To describe the 10-year evolution of a cohort of migraine patients, focusing on prognostic factors of improvement.

Background: Migraine is one of the most prevalent and disabling diseases and migraineurs often want to know about the evolutionary timeline of their condition. Yet, data from longitudinal studies with a long-term follow-up is scarce.

Methods: This is a 10-year longitudinal study. In 2008, we recruited 1109 consecutive migraine patients who answered an initial survey. In 2018, we did a follow-up. We compared initial and final (after 10 years) data. A reduction ≥50% in Headache days/month was considered as improvement. A comparative study was carried out to identify predictors of improvement or no improvement.

Results: After 10 years, 380 patients completed the survey (34.3% of the initial cohort), 77.1% (293/380) were women; mean age 41.0 ± 10.6 years and 73.7% (280/380) had an initial diagnosis of episodic migraine (EM). After 10 years, 48.2% (183/380) of patients did not have a medical follow-up of their migraine; 47.4% (180/380) decreased ≥50% in frequency, which increased the proportion of EM (73.7% vs 87.4%) (P < .001) as compared to the initial results. Factors independently associated with improvement were: a baseline frequency >10 days/month (OR[95%]: 3.04 [1.89, 4.89]; P < .001), nonsmoking (2.13 [1.23, 3.67]; P = .006) and a medical follow-up for migraine (2.45 [1.54, 3.90]; P < .001). Additionally, after 10 years, we observed a reduction in the use of preventive treatment (48.7% vs 23.5%) and an increase in monotherapy (42.2% vs 72.7%) (P < .001).

Conclusion: After 10 years, in almost half of the patients who answered the survey, migraine improved. Other than the natural pathophysiology of migraine, having a medical follow-up and healthy habits such as nonsmoking were independent factors associated with improvement.

Keywords: chronic migraine; epidemiology; evolution; migraine; prognosis.

MeSH terms

  • Adult
  • Comorbidity
  • Female
  • Follow-Up Studies
  • Habits
  • Health Surveys
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Migraine Disorders / diagnosis
  • Migraine Disorders / drug therapy*
  • Migraine Disorders / epidemiology
  • Migraine Disorders / physiopathology*
  • Prescription Drug Overuse
  • Prognosis
  • Severity of Illness Index