Data from a study released this month in Headache: The Journal of Head and Face Pain, confirms once again a major point we've discussed about transformed Migraine. When medications that are being overused and leading to medication overuse headaches are discontinued, there is significant improvement in headache frequency and transformed Migraine reverts back to episodic Migraine without chronic daily headache.

Study objective

To identify the factors contributing to the reversion of transformed Migraine (TM) into episodic Migraine.
 

Study method

• 145 of 1,142 consecutive headache patients seen at the Headache Clinic of the Samsung Medical Center met the criteria for diagnosis of transformed Migraine, and their progress was followed for at least one year.
• At initial assessment, data was collected on
  • headache profile based on International Headache Society diagnostic criteria
  • medical history including information regarding medication overuse, chronic use of analgesics for other conditions, coexisting chronic illnesses, caffeine consumption in excess of 100mg daily, alcohol consumption, smoking, family medical history
  • lifestyle details including exercise
• Management protocol:
  • abrupt discontinuation of overused medications
  • compliance with preventive regimen
  • lifestyle modifications including regular exercise, elimination of caffeine and alcohol, smoking cessation
     

Study results

• 136 of the initial 145 patients finished the the study through final follow-up assessment 1 year after the initial evaluation.
• Five patients were lost to follow-up and 4 patients refused the follow-up interview.
• Of the 136 patients:
  • 122 were women.
  • In 95 (70%) patients, their transformed Migraines converted to episodic Migraine
  • 41 (30%) continued to suffer daily headaches without a period of improvement
  • 10 did not discontinue overused drugs. None of them improved to episodic Migraine
• The 2 major reasons for poor compliance with preventive medication regimens were side effects and
  low efficacy
• Significant positive factors in reversion of transformed Migraine to episodic:
  • Good compliance with preventive regimen
  • withdrawal from continuous use of analgesics for headache relief (medication overuse)
  • regular exercise
  
   

Study conclusion

Compliance factors are the most important factors that determine the reversion of transformed Migraine into episodic Migraine.
 

Summary

Transformed Migraine is Migraine disease which began manifesting in episodic Migraine attacks, increasing in frequency and changing characteristics, and resulting in almost daily less severe headaches punctuated by severe and debilitating Migraine attacks. Overuse of pain relievers has long been noted as a major contributing factor to transformed Migraine. This study confirms that ending medication overuse is necessary if transformed Migraine is to lose its characteristics of chronic daily headache and return to episodic Migraine. Episodic Migraine can then be managed with effective preventive medications and abortive medications as necessary.
 

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Resources

Seok, Jung Im, Cho, Hyung In & Chung, Chin-Sang (2006). From Transformed Migraine to Episodic Migraine: Reversion Factors. Headache: The Journal of Head and Face Pain 46 (7), 1186-1190. doi: 10.1111/j.1526-4610.2006.00509.x
 

© Teri Robert, August 1, 2006

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