Update on Migraine Incidence and Risk for Progression from Episodic to Chronic Migraine

At the Virtual Scottsdale Headache Symposium 2020, Richard Lipton, MD presented the latest data from epidemiology studies of migraine. Dr. Lipton noted that epidemiologic studies not only provide a conceptual model of the disease and approaches for better understanding but also help to assess and reduce barriers to care.

Migraine is common chronic disease with episodic attacks, affecting 18% of women and 6% of men and is disabling and sometimes progressive. Twin studies show a monozygotic concordance of 40% to 60% and dizygotic concordance of 20% to 30%, suggesting that genetic factors account for 50% of the risk of having migraine.

Chronic migraine, defined as 15 headache days/month, 8 of which have migraine-like features, is a progression from episodic migraine and carries a higher level of disability and disease burden. Of those with episodic migraine, 2.5% have progression to chronic migraine annually. Risk factors for progression that should be assessed in anyone with migraine include obesity, depression, allodynia, use of opiates or barbiturates, and poor response to acute treatment. Migraine with or without aura increased the risk of cardiovascular disease, particularly in people over age 60 and more so in men compared with women. 

Of 1,254 people with chronic migraine headache-related disability, 59.2% were not accessing any care for their headache condition. Of the 40.8% who were accessing care, 75.4% were not diagnosed despite meeting criteria for a primary headache disorder (according to the International Classification of Headache Disorders, 3rd edition). For the 10% who diagnosed care and were diagnosed, only 44.4% received appropriate acute treatments. Together these results show that only 4.5% had access to care, received appropriate diagnosis, and received appropriate acute treatment, which is recommended by the American Headache Society for all people with migraine. For those with episodic migraine, only 26.3% had access to care, appropriate diagnosis, and appropriate acute treatment.

Dr. Lipton concluded that use of direct-to-patient and in-office can improve access to care and office-based screening and medical education can improve diagnosis, ultimately to improve treatment to reduce the burden of disease.