Predictors of episodic migraine transformation to chronic migraine: A systematic review and meta-analysis of observational cohort studies

Abstract

Background and purpose An estimated 2.5–3.1% of people with episodic migraine develop chronic migraine in a year. Several risk factors are associated with an increased risk for this transformation. We conducted a systematic review and meta-analysis to provide quantitative and qualitative data on predictors of this transformation. Methods An electronic search was conducted for published, prospective, cohort studies that reported risk factors for chronic migraine among people with episodic migraine. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. Quality of evidence was determined according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Effect estimates were retrieved and summarized using risk ratios. Results Of 5695 identified publications, 11 were eligible for inclusion. The pooled analysis (GRADE system) found “high” evidence for monthly headache day frequency ≥ 10 (risk ratio = 5.95), “moderate” evidence for depression (risk ratio = 1.58), monthly headache day frequency ≥ 5 (risk ratio = 3.18), and annual household income ≥ $50,000 (risk ratio = 0.65) and “very low” evidence for allodynia (risk ratio = 1.40) and medication overuse (risk ratio = 8.82) in predicting progression to chronic migraine. Conclusions High frequency episodic migraine and depression have high quality evidence as predictors of the transformation from episodic migraine to chronic migraine, while annual household income over $50,000 may be protective.

Economic burden and risk factors of migraine disease progression in the US: a retrospective analysis of a commercial payer database

“…However, previous epidemiological studies have identified risk factors for progression to CM. These established risk factors include overuse of medications such as triptans, high headache frequency, allodynia, obesity, caffeine consumption, snoring, depression, neck/head trauma, and other comorbidities [12][13][14][15][16][17][18][19][20] . Socioeconomic factors such as low income and low education were found to be significantly associated with progression of migraine 13,14 .…”

Medication Overuse and Headache Burden

“…AMO is associated with the risk of migraine disease progression from episodic migraine (EM) to chronic migraine (CM). 9 , 13 , 28 , 29 In the AMPP study, triptan overuse alone was associated with risk of disease progression from EM to CM depending on the baseline frequency of MHDs; however, triptan use in combination with NSAIDs was not associated with an increased risk of progression, and NSAID use may be protective of progressing from EM to CM depending on MHDs. 13 , 28 , 30 In addition, opioids and barbiturate analgesics are associated with dose-dependent increased risk of CM onset across a range of frequencies.…”

Plasma levels of CGRP and expression of specific microRNAs in blood cells of episodic and chronic migraine subjects: towards the identification of a panel of peripheral biomarkers of migraine?

“…Chronic migraine (CM) is a highly disabling condition that frequently manifests as a negative evolution of episodic migraine (EM) in a process that takes place over years [1]. In a recent meta-analysis on the predictors of migraine chronification, a number of monthly headache days ≥ 10 showed the strongest level of evidence, with depression and low household income being supported by moderate evidence [2]. In the same meta-analysis, medication overuse (MO) was associated to the highest risk ratio in a random-effects model (RR 8.82; 95% CI, 2.88-27), although the strength of evidence was rated 'very low'due to substantial heterogeneity among studies.…”