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Predictability of Future Attacks by Migraineurs: A Prospective Observational Study

Authors

  • X. Henry Hu MD, PhD,

    1. From the Global Health Outcomes, Merck & Co., Inc., Whitehouse Station, NJ, USA (X.H. Hu, W. Golden, B. Katic, and Y.-T. Chen); Consumer Health Sciences International (a KantarHealth company), Princeton, NJ, USA (S.C. Bolge and S. Wagner); Banyan Group Inc., Headache Care Center, Springfield, MO, USA (R. Cady).
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  • Wendy Golden MD, MPH,

    1. From the Global Health Outcomes, Merck & Co., Inc., Whitehouse Station, NJ, USA (X.H. Hu, W. Golden, B. Katic, and Y.-T. Chen); Consumer Health Sciences International (a KantarHealth company), Princeton, NJ, USA (S.C. Bolge and S. Wagner); Banyan Group Inc., Headache Care Center, Springfield, MO, USA (R. Cady).
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  • Susan C. Bolge PhD,

    1. From the Global Health Outcomes, Merck & Co., Inc., Whitehouse Station, NJ, USA (X.H. Hu, W. Golden, B. Katic, and Y.-T. Chen); Consumer Health Sciences International (a KantarHealth company), Princeton, NJ, USA (S.C. Bolge and S. Wagner); Banyan Group Inc., Headache Care Center, Springfield, MO, USA (R. Cady).
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  • Bozena Katic MPH, MA,

    1. From the Global Health Outcomes, Merck & Co., Inc., Whitehouse Station, NJ, USA (X.H. Hu, W. Golden, B. Katic, and Y.-T. Chen); Consumer Health Sciences International (a KantarHealth company), Princeton, NJ, USA (S.C. Bolge and S. Wagner); Banyan Group Inc., Headache Care Center, Springfield, MO, USA (R. Cady).
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  • Ya-Ting Chen PhD, MPH,

    1. From the Global Health Outcomes, Merck & Co., Inc., Whitehouse Station, NJ, USA (X.H. Hu, W. Golden, B. Katic, and Y.-T. Chen); Consumer Health Sciences International (a KantarHealth company), Princeton, NJ, USA (S.C. Bolge and S. Wagner); Banyan Group Inc., Headache Care Center, Springfield, MO, USA (R. Cady).
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  • Samuel Wagner PhD,

    1. From the Global Health Outcomes, Merck & Co., Inc., Whitehouse Station, NJ, USA (X.H. Hu, W. Golden, B. Katic, and Y.-T. Chen); Consumer Health Sciences International (a KantarHealth company), Princeton, NJ, USA (S.C. Bolge and S. Wagner); Banyan Group Inc., Headache Care Center, Springfield, MO, USA (R. Cady).
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  • Roger Cady MD

    1. From the Global Health Outcomes, Merck & Co., Inc., Whitehouse Station, NJ, USA (X.H. Hu, W. Golden, B. Katic, and Y.-T. Chen); Consumer Health Sciences International (a KantarHealth company), Princeton, NJ, USA (S.C. Bolge and S. Wagner); Banyan Group Inc., Headache Care Center, Springfield, MO, USA (R. Cady).
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  • Conflict of Interest: Drs. Hu, Golden, and Chen are employees of Merck & Co., Inc, manufacturer of Maxalt®, an acute treatment for migraine. Dr. Cady conducts research and serves on advisory boards for Merck & Co., Inc. This study was funded by Merck & Co., Inc.

X. Henry Hu, Merck & Co., Inc., 770 Sumneytown Pike, PO Box 4, WP97-B340, West Point, PA 19486, USA.

Abstract

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)

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