Development and Internal Validation of a Multivariable Prediction Model for Individual Episodic Migraine Attacks Based on Daily Trigger Exposures

Abstract

Objective To develop and internally validate a multivariable predictive model for days with new‐onset migraine headaches based on patient self‐prediction and exposure to common trigger factors. Background Accurate real‐time forecasting of one’s daily risk of migraine attack could help episodic migraine patients to target preventive medications for susceptible time periods and help decrease the burden of disease. Little is known about the predictive utility of common migraine trigger factors. Methods We recruited adults with episodic migraine through online forums to participate in a 90‐day prospective daily‐diary cohort study conducted through a custom research application for iPhone. Every evening, participants answered questions about migraine occurrence and potential predictors including stress, sleep, caffeine and alcohol consumption, menstruation, and self‐prediction. We developed and estimated multivariable multilevel logistic regression models for the risk of a new‐onset migraine day vs a healthy day and internally validated the models using repeated cross‐validation. Results We had 178 participants complete the study and qualify for the primary analysis which included 1870 migraine events. We found that a decrease in caffeine consumption, higher self‐predicted probability of headache, a higher level of stress, and times within 2 days of the onset of menstruation were positively associated with next‐day migraine risk. The multivariable model predicted migraine risk only slightly better than chance (within‐person C‐statistic: 0.56, 95% CI: 0.54, 0.58). Conclusions In this study, episodic migraine attacks were not predictable based on self‐prediction or on self‐reported exposure to common trigger factors. Improvements in accuracy and breadth of data collection are needed to build clinically useful migraine prediction models.

Impact of the COVID-19 pandemic on migraine in Japan: a multicentre cross-sectional study

“…In a study from China performed during the COVID-19 outbreak, patients with migraine had significantly higher levels of stress than the controls [ 23 ]. In a 90-day prospective daily-diary cohort study involving adults with episodic migraine, increased levels of stress were associated with the risk of migraine the next day [ 24 ]. During the COVID-19 pandemic, perceived stress was more strongly associated with brooding and COVID-related rumination among patients with migraine than healthy controls [ 25 ].…”

Evaluation of the Impact of the COVID-19 Lockdown in the Clinical Course of Migraine

“…This lack of details about lifestyle habits and the nature of the study makes it difficult to establish clear causal relationships. Moreover, according to a recent study, only a few reported triggers (higher stress, menstruation and lower caffeine intake) are useful to establish a model to predict migraine attacks based on triggers [ 54 ], considering that the obtained model presented a prediction capability slightly higher than chance. This result indicates that there is a high variability of the individual trigger effects between patients with migraine, making particularly difficult to associate a specific trigger with migraine outcomes.…”

Ponytail headache (external-traction headache): prevalence, characteristics and relationship with migraine

“…In migraine, the ability of external factors to trigger headache attacks is well known. [8][9][10][11] Furthermore, surgeries were developed considering anatomical sites' existence as a possible anatomical triggering of headache attacks. [12][13][14][15] The highest prevalence of ponytail headache may be explained by the theory of peripheral and central sensitization of the nociceptive system of migraineurs.…”