Predictability of Future Attacks by Migraineurs: A Prospective Observational Study

• Published in: Headache 2010-09, Vol.50 (8), p.1296-1305
• Main Authors: Hu, X. Henry, Golden, Wendy, Bolge, Susan C., Katic, Bozena, Chen, Ya-Ting, Wagner, Samuel, Cady, Roger
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adult; Anxiety - epidemiology; Anxiety - psychology; Attitude to Health; Biological and medical sciences; Cardiovascular system; Comorbidity; Drugs; Female; Forecasting; headache; Humans; Male; Medical sciences; Middle Aged; Migraine; Migraine Disorders - diagnosis; Migraine Disorders - epidemiology; Migraine Disorders - psychology; National Health and Wellness Survey; Neurology; Pharmacology. Drug treatments; Predictive Value of Tests; Prospective Studies; Questionnaires; Surveys and Questionnaires - standards; Vascular diseases and vascular malformations of the nervous system; Vasodilator agents. Cerebral vasodilators
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/j.1526-4610.2010.01630.x

Objective.— To determine the predictability of future migraine attacks and to describe the effect of migraine on daily life during and between migraine attacks. Background.— Migraine is associated with substantial economic and humanistic burden. There is growing evidence that early intervention with triptans results in better treatment outcomes. However, this is dependent on a patient's preparedness for an attack including having abortive medications readily accessible at headache onset. Methods.— Physician‐diagnosed adult migraine sufferers, who treat with prescription or over‐the‐counter medications, completed 2 self‐reported, Internet‐based questionnaires, administered at baseline and following the resolution of the next migraine attack. The baseline questionnaire included the Migraine Disability Assessment questionnaire (MIDAS), questions about experiences on days between attacks, predictions of the date, time of day (5 time windows), and sufferer's location (4 places) at the start of their next migraine. At follow‐up, information was collected in the similar fashion about the date, time of day, and sufferer's location at the start of their most recent migraine. Results.— A total of 1519 migraine sufferers completed the baseline questionnaire and 877 (57.7%) completed the follow‐up. At baseline, 58.7% experienced moderate to severe disability from headache, based on MIDAS. Only 4.0% were able to predict the exact date of their next migraine; 21.24% predicted next migraine within 3 days. Larger proportions (46.6%) were able to accurately predict time of day or location (70.7%) of their next migraine. In the past 3 months, 92.6% reported that they were forced to change daily plans because of migraine. Because of fear of getting a migraine, 20.2% had avoided and 27.0% had changed a work commitment, and 27.3% had avoided and 28.2% had changed social plans. Conclusions.— Migraine sufferers are generally unable to predict onset of the next migraine. Lack of predictability heightens the importance of education and preparedness for a migraine attack which may also reduce fear and anxiety between attacks. (Headache 2010;50:1296‐1305)