CHICAGO – Migraine appears to have a favorable long-term prognosis in many patients, with more than a third experiencing cessation of headache and the vast majority of persistent migraineurs reporting symptom improvement over 12 years.
“These data probably reflect the natural course of migraine disease,” Dr. Carl Dahlöf said at the annual meeting of the American Headache Society. “They also probably suggest that we are doing a better job with the newer drugs, and appear to be preventing episodic migraineurs from developing chronic migraine.”
Dr. Dahlöf of the Göteborg (Sweden) Migraine Clinic presented 12 years of follow-up data obtained on 374 patients diagnosed with migraine before 1996. The group included 200 men and 174 women, a ratio that does not reflect the gender balance seen in any headache practice, Dr. Dahlöf noted. “We chose equal numbers of men and women because we wanted to see if there were any gender differences in progression or improvement over the years.”
All patients participated in a telephone survey that assessed the changing pattern of their migraine from 1994 to 2006.
Over the follow-up period, 29% of patients (57 women and 53 men) reported that their migraines had ceased. For women, migraine without aura, the absence of hereditary factors, and the absence of aggravation from physical activity appeared to predict cessation. For men, the apparent predictors were a nonthrobbing migraine, and the absence of nausea and sensitivity to smells.
“Surprisingly, we also found in men that smoking and lack of alcohol as a trigger factor were also predictors,” Dr. Dahlöf said. “We had expected that more frequent or severe migraine would predict progression, but we did not find this as true.”
The remaining 264 patients continued to experience migraine, but the majority reported at least some improvement of their symptoms over time.
In all, 80% reported a change in headache frequency, with 80% of these saying they had fewer attacks per month.
More than half of persistent migraineurs reported a change in duration of headache, with 66% saying their attacks had grown shorter. In terms of severity, 66% of migraineurs reported a change in pain intensity over time, with most of this group (84%) reporting milder pain.
Of the entire group of 374 patients, only six (1.6%) developed chronic migraine, a number that is vastly smaller than the annual transformation rate reported in many studies, Dr. Dahlöf said.
Despite the changing pattern of migraine, a significant proportion of migraineurs continued to experience impairment in their quality of life, including decreased family and social functioning, and absence from work.