Prognostic factors of therapeutic response in chronic migraine and medication overuse headache

Introduction. The treatment of patients with chronic migraine (CM) and medication overuse headache (MOH) is an actual problem in neurology. Predictors of treatment effectiveness for CM and MOH have been poorly studied.

Aim. To study the prognostic factors of therapeutic response in CM.

Materials and methods. 54 patients (11 men, 43 women) with CM aged 18 to 50 years (average age 39 years), with or without MOH received preventive treatment for 12 months with evaluation of results every 2 months. Patients kept a headache diary. The questionnaire took place during each visit and included assessments using the VAS (Visual Analog Scale), SF-36 (SF-36 Health Status Survey), MIDAS (Migraine Disability Assessment), MSQ v2.1 (Migraine Specific Quality of Life Questionnaire version 2.1), Morisky – Green Medication Adherence Scale, Sleep Quality Questionnaire, CSI-A (Central Sensitization Inventory), LDQ (Leeds Dependence Questionnaire), HIT-6 (Headache Impact Test-6), HADS (Hospital Anxiety and Depression Scale).

Results. The baseline monthly migraine frequency was associated with the MSQ v2.1 (restrictive function: β = -0.17, preventive function: β = -0.14, emotional function: β = -0.06, p < 0.001), SF-36 (PH: β = -0.37, MH: β = -0.02, p < 0.001), LDQ (β = 0.5, p < 0.001), HIT-6 (β = 0.47, p < 0.001), CSI-A (β = 0.19, p < 0.001) scores. The baseline MIDAS score was associated with the results of the LDQ (β = 6.1, р < 0.001), CSI-A (β = 2, р < 0.001), HIT-6 (β = 3.46, р < 0.001), НАDS-A (β = 4.5, р < 0.001), HADS-D (β = 2.82, р = 0.014), SF-36 (PH: β = -3.4, MH: β = -2, р < 0.001), MSQ v2.1 (restrictive function: β = -1.66, preventive function: β = -1.77, emotional function: β = -0.9, p < 0.001) and Sleep Quality Questionnaire (β = -4.5, р < 0.001). However, these factors were not associated with the dynamics of reduction in the frequency of headaches and MIDAS. On the background of preventive therapy headache frequency decreased by 2 episodes per month (β = -2.15, p < 0.001), and the MIDAS score decreased by almost 9 points (β = -8.95, p < 0.001). MOH was not a significant predictor of migraine dynamics (p = 0.072) and severity on the MIDAS scale (p = 0.24).

Conclusion. The duration of preventive treatment under the control of a specialist is the main predictor of a positive therapeutic response in CM and MOH.

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