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Does the Pattern of Migraine Change over Time?
A 12-Year Perspective
Dahlof C, Johansson M, Mellberg A.
Posted: June 2007  
Abstract presented at American Headache Society Meetng
June 7-11, 2007, Chicago, IL
Headache 2007;47:750

Objectives:   Presented here are the findings of 12 years’ follow-up of migraineurs managed at the Gothenburg Migraine Clinic, Sweden.

Background:   Despite the prevalence of migraine, relatively little is known in terms of whether migraine represents a progressive disorder that worsens over time.

Methods:   374 patients (200 women, 174 men) of average age 55.5 (range 19-87) years were randomly selected from a total population of 2812 patients with episodic migraine and an attack frequency of 1-6 attacks per month. Telephone interviews were conducted to evaluate the changing pattern of migraine between 1994 and 2006, in terms of the proportion of patients who became symptom-free and frequency/duration/severity of migraine attacks among persistent migraineurs, including quality of life impairment and work absence. Satisfaction with current treatment and subjective benefits of early vs. late treatment were also determined.

Results:   Over the 12-year period, migraine had resolved in 110/374 patients. Among the remaining 264 patients who continued to experience migraine at 12 years’ follow-up, 80% reported a change in frequency of migraine (of these, 80% reported a decrease in frequency of attacks/month) and 55% reported a change in duration of attacks (of these, 66% experienced shorter attacks). In terms of severity, 66% of migraineurs reported a change in pain intensity over time (of these 84% reported milder pain at 12 years’ follow-up). Of the studied population only 6 subjects had developed chronic migraine. Despite the changing pattern of migraine, a significant proportion of migraineurs continued to experience quality of life impairment (including decreased family/social functioning) and/or work absence. Satisfaction with current medication was high, perhaps due to the high proportion using triptans. Overall, patients reported a marked benefit in terms of earlier initiation of treatment.

Conclusions:   These findings indicate that migraine does not appear to be a progressive disorder in most patients. In fact, many persistent migraineurs reported less frequent, shorter and/or milder attacks over time, which probably reflects the improvements in available treatment options (most notably triptans in different formulations) and/or migraine management over the last 12 years, particularly as this group of patients have been actively treated at a specialist migraine clinic over this time.