Risk factors for migraine disease progression: a narrative review for a patient-centered approach

Richard B Lipton, Dawn C Buse, Stephanie J Nahas, Gretchen E Tietjen, Vincent T Martin, Elin Löf, Thomas Brevig, Roger Cady, Hans-Christoph Diener, Richard B Lipton, Dawn C Buse, Stephanie J Nahas, Gretchen E Tietjen, Vincent T Martin, Elin Löf, Thomas Brevig, Roger Cady, Hans-Christoph Diener

Abstract

Background: In individuals with migraine, attacks may increase in frequency, severity, or both. Preventing migraine progression has emerged as a treatment goal in headache subspecialty practice, but there may be less awareness in general neurology or primary care settings where most people with migraine who seek treatment consult. Herein, we review the definition of and risk factors for migraine progression and consider strategies that could reduce its risk.

Methods: A group of headache expert healthcare professionals, clinicians, and researchers reviewed published evidence documenting factors associated with increased or decreased rates of migraine progression and established expert opinions for disease management recommendations. Strength of evidence was rated as good, moderate, or based solely on expert opinion, using modified criteria for causation developed by AB Hill.

Results: Migraine progression is commonly operationally defined as the transition from ≤ 15 to ≥ 15 monthly headache days among people with migraine; however, this does not necessarily constitute a fundamental change in migraine biology and other definitions should be considered. Established and theoretical key risk factors for migraine progression were categorized into five domains: migraine disease characteristics, treatment-related factors, comorbidities, lifestyle/exogenous factors, and demographic factors. Within these domains, good evidence supports the following risk factors: poorly optimized acute headache treatment, cutaneous allodynia, acute medication overuse, selected psychiatric symptoms, extra-cephalic chronic pain conditions, metabolism-related comorbidities, sleep disturbances, respiratory conditions, former/current high caffeine intake, physical inactivity, financial constraints, tobacco use, and personal triggers as risk factors. Protective actions that may mitigate migraine progression are sparsely investigated in published literature; our discussion of these factors is primarily based on expert opinion.

Conclusions: Recognizing risk factors for migraine progression will allow healthcare providers to suggest protective actions against migraine progression (Supplementary Fig. 1). Intervention studies are needed to weight the risk factors and test the clinical benefit of hypothesized mitigation strategies that emerge from epidemiological evidence.

Keywords: Chronic migraine; Episodic migraine; Migraine progression; Prevention strategies; Risk factors.

Conflict of interest statement

Dr. Lipton has been a consultant, advisory board member, and/or has received honoraria from Allergan/AbbVie, American Academy of Neurology, American Headache Society, Amgen, BioDelivery Sciences, Biohaven Pharmaceuticals, BioVision, electroCore, Eli Lilly, GlaxoSmithKline, Impel, Lundbeck Seattle BioPharmaceuticals, Merck, Pernix, Pfizer, Supernus, Teva, Trigemina, Vector, and Vedanta; has stock or stock options in Biohaven Pharmaceuticals and Manistee; and has received research support from Amgen, the FDA, the National Headache Foundation, and the NIH. Dr. Buse has received grant support from Amgen, the FDA, and the National Headache Foundation; has served as a consultant and received honoraria from Allergan/AbbVie, Amgen/Novartis, Biohaven, Collegium, Eli Lilly, Lundbeck, and Teva; and has served on the editorial board of Current Pain and Headache Reports. Dr. Nahas has received honoraria for consulting from Alder/Lundbeck, Allergan/AbbVie, Amgen/Novartis (inactive), Axsome (inactive), BioDelivery Sciences (inactive), Biohaven (inactive), Eli Lilly, Fenix Group International (inactive), Teva (inactive), and Theranica (inactive); has received honoraria for speaking from Allergan/AbbVie, Amgen/Novartis, Eli Lilly, and Teva (all inactive); has received honoraria for work in education or publishing from American Academy of Neurology, American Headache Society, Evolve Med Ed, Massachusetts Medical Society, MedLink Neurology, MJH Life Sciences, NACCME, Neurology Learning Network, Pennsylvania Neurologic Society, Pri-Med, Springer, WebMD/Medscape, and Wolters-Kluwer; and has received legal fees for serving as a medical expert to Jackson & Campbell. Dr. Tietjen has been a consultant for Lundbeck and Impel; has presented lectures for CME Outfitters and American Medical Women’s Association; has received an award from the American Headache Society; has received support for teaching or presenting in meetings at the Annual Scientific Meeting of the American Headache Society and Annual Meeting of the American Academy of Neurology; has been a committee chair member for the American Headache Society; and owns stock or an ownership interest in Johnson & Johnson. Dr. Martin has been a consultant for AbbVie, Biohaven, Theranica, Impel, Bioscience Delivery, and Lundbeck, and has been a speaker for AbbVie, Impel, Lundbeck, and Satsuma. Dr. Löf is an employee of Lundbeck or one of its subsidiary companies. Dr. Brevig and Dr. Cady were previously employees of Lundbeck. Prof. Diener has received honoraria for contribution to advisory boards or oral presentations from Eli Lilly, Lundbeck, Novartis, Pfizer, and Teva; has received research support from the German Research Council (DFG), and the German Ministry of Education and Research (BMBF); has served on the editorial boards of Cephalalgia, Lancet Neurology, and Drugs; and has served as a member of the Clinical Trials Committee of the IHS.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
A model of migraine disease progression. *See Table 1

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