From Transformed Migraine to Episodic Migraine: Reversion Factors

Abstract

To identify the factors contributing to the reversion of transformed migraine (TM) into episodic migraine. TM, the most common and important subtype of chronic daily headache (CDH), has a great effect on a patient's quality of life. However, its clinical course and outcome predictors have rarely been studied prospectively. Of 1142 consecutive headache patients seen at the Headache Clinic of the Samsung Medical Center, the patients with TM (frequency >15/month for >6 months and a history of migraine meeting the ICHD-II diagnostic criteria) were followed for at least 1 year. We analyzed the demographic data, clinical course, and compliance factors, such as those of the physician's management protocol and recommended lifestyle modification. A total of 136 patients finished the final follow-up assessment 1 year after the initial evaluation. Ninety-five patients (70%) converted from TM to episodic migraine. Forty-one patients (30%) continued to suffer daily headaches without a period of improvement. The demographic and clinical information collected before the treatment was not significantly related to outcome, except for chronic use of analgesics for other medical conditions (P= .01). Of the compliance factors, good compliance with preventive medication (P < .001), withdrawal from continuous use of analgesics for headache relief (P < .001), and regular exercise (P= .04) were significant positive contributors to the reversion of TM into episodic migraine. Compliance factors are the most important factors that determine the reversion of TM into episodic migraine.