Frequency and Burden of Headache-Related Nausea: Results From the American Migraine Prevalence and Prevention (AMPP) Study
- Conflict of Interest: Dr. Lipton has received grants from Allergan Pharmaceuticals, Endo Pharmaceuticals, GlaxoSmithKline, Minster, Merck, Neuralieve, Novartis, Ortho-McNeil, Pfizer, NuPathe, the National Headache Foundation, and the National Institutes of Health. He has received honoraria from Allergan Pharmaceuticals, AstraZeneca, Endo Pharmaceuticals, GlaxoSmithKline, MAP, Merck, Novartis, Ortho-McNeil, and Pfizer. Dr. Buse has received grant support and honoraria from Allergan Pharmaceuticals, Endo Pharmaceuticals, Iroko Pharmaceuticals, MAP Pharmaceuticals, Merck & Co., Inc., Novartis, and NuPathe. Dr. Saiers has received funding for medical writing from GlaxoSmithKline, Nupathe, and the American Headache Society. Dr. Fanning has received research support from Allergan Pharmaceuticals, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck & Co., Inc., NuPathe, Novartis, Ortho-McNeil, and the National Headache Foundation. Dr. Serrano has received research support from Allergan Pharmaceuticals, CoLucid, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck & Co., Inc., NuPathe, Novartis, Ortho-McNeil, and the National Headache Foundation. Dr. Reed has received funding for research and data analysis from Allergan Pharmaceuticals, CoLucid, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck & Co., Novartis, NuPathe, Ortho-McNeil, and the National Headache Foundation.
- Funding: AMPP is funded through a research grant to the National Headache Foundation from Ortho-McNeil Neurologics, Inc., Titusville, NJ, USA. This analysis was funded with an additional research grant from NuPathe, Inc., Conshohocken, PA, USA, to the National Headache Foundation.
While nausea is a defining feature of migraine, the association of nausea with other headache features and its influence on the burden of migraine have not been quantified. Population-based data were used to elucidate the relative frequency and burden of migraine-associated nausea in persons with migraine.
Participants with episodic migraine who completed the 2009 American Migraine Prevalence and Prevention survey rated their headache-related nausea as occurring none of the time, rarely, <half the time, or ≥half the time with their headaches. They also completed headache symptom severity and occupation/work status questions, the Headache Impact Test-6, and treatment attitude items that were part of the 2009 survey. Regression models that adjusted for both sociodemographic characteristics and symptom severity were used to assess the influence of nausea frequency on outcome measures. Partial and semipartial correlational analyses were used to estimate the influence of nausea alone and in combination with other headache symptoms on headache-related impact.
Among the 6488 respondents with episodic migraine, approximately half (49.5%) reported high-frequency nausea (ie, ≥half the time) with headache. High-frequency nausea was more common in females than males (adjusted odds ratio 1.35, 95% confidence interval 1.26-1.44). Persons with high-frequency nausea, compared with the no/rare or less than half the time nausea groups, reported significantly more headache symptoms and more headache-related impact as measured by the Headache Impact Test-6. High-frequency nausea was also associated with being occupationally disabled or on medical leave, and more self-reported financial burden of headache medications, worry about running out of headache medication(s), and that headache medications interfered with work or school work, household work, and family/leisure activities. Regression-based correlational analyses indicated that nausea contributes significantly and independently to headache-related impact.
High-frequency migraine-associated nausea is common and is a marker for severe, debilitating migraine. Nausea makes an independent contribution to migraine-associated disability and impact. Management strategies that take nausea into account could reduce the burden of migraine. Nausea is an important target for monitoring and treatment.