High Frequency Episodic Migraine Has Similar Burden to Low Frequency Chronic Migraine

June 19, 2020

Treatment needs of those with high frequency episodic migraine may be similar to those with low frequency chronic migraine.

ichard B. Lipton, MD

Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study suggest there is a substantial overlap in measures of burden and depression among patients who self-responded with high frequency episodic migraine (HFEM) and those with low frequency chronic migraine (LFCM).

The research, presented virtually at the 2020 American Headache Society (AHS) Annual Meeting by Richard B. Lipton, MD, professor and vice chair of neurology, Albert Einstein College of Medicine, showed that 12.8%, 51.9%, 66.3%, and 70.1% of the low frequency episodic migraine (LFEM), HFEM, LFCM, and high frequency chronic migraine (HFCM) groups experienced severe disability, respectively.

Severe disability, graded by scores of at least 4 on the Migraine Disability Assessment Scale (MIDAS), were recorded in 16,789 respondents, of which 13,473 were LFEM, 1840 were HFEM, 1035 were LFCM, and 441 were HFCM. Using the Migraine Interictal Burden Scale (MIBS), severe scores of ≥5 were reported by 19.2%, 38.2%, 46.7%, and 58.3% of respondents in the 4 subgroups, respectively. In addition to that finding, moderate interictal burden, or scores between 3—4, were found in 17.9% and 17.0% of patients in HFEM and LFCM, respectively.

Depression, defined as scores of ≥10 on the 9-item Patient Health Questionnaire (PHQ-9), was reported by 27.6%, 47.3%, 54.9%, and 60.8% of respondents in the monthly headache day (MHD) subgroups, respectively.

Within both the HFEM and LFCM groups, allodynia was found in 57.5% and 61.7% of the populations, while mean migraine symptom severity (MSSS) was 16.07 (standard deviation [SD], 3.1) and 16.72 (SD, 2.9), respectively. Scores of ≥10 on the 7-item Generalized Anxiety Disorder Scale (GAD-7) were observed in 41.9% of HFEM patients compared to 46.9% in those with LFCM.

In addition to the similarities in burden and severity, patients in both groups had similar percentages of patients being managed by a healthcare professional (HFEM: 32.3%; LFCM: 36.5%), as well as seeing a specialist (HEFM: 8%; LFCM: 11.9%) and going into the emergency department for visit for headache in the past 6 months (HEFM: 10.2%; LFCM: 10.3%).

When observing treatment patterns, 22% of HFEM patients and 27.7% of LFCM patients used some sort of preventive treatment. Triptans (16.1% vs 18.4%) and nonsteroidal anti-inflammatory drugs (NSAIDs) also had similarities in usage (16.1% vs 17.0%).

Researchers concluded that the similarities in results in patients with HFEM and LFCM indicate that treatment needs may be similar and adding the doubt to the utility of the diagnostic labeling.

CaMEO’s aim was to characterize the burden of migraine across MHD subgroups by assessing headache-related disability and burden. Patients included in the study had met modified International Classification of Headache Disorders, 3rd edition criteria for migraine, and answered questions on demographics, headache features, disability, interictal burden and depression.

The classification of the 4 subgroups was based on self-reported number of MHDs. Patients with LFEM had between 0—7, HFEM between 8–14, LFCM between 15–23, and HFCM had ≥24 MHDs. Researchers used linear-by-linear association test and 2-sided chi statistics to evaluate the trends in MHDs.

Jessica Ailani, MD, director, MedStar Georgetown Headache Center, and associate professor, neurology, MedStar Georgetown University Hospital, discussed the CaMEO study data with NeurologyLive at the 2019 AHS Annual Meeting, stating “There is a lot of data out there that shows that it's a struggle to get the diagnosis of migraine, but once you get the diagnosis and you're given a prescription, what happens then?” She goes on to provide further detail on what the data ultimately can tell physicians about patients with migraine, and how it can affect treatment options.2


1. Lipton RB, Reed ML, Fanning KM. Exploring the boundaries between episodic and chronic migraine: results from the cameo study. Headache. 2020;60(S1 suppl). 1—156. doi: 10.1111/head.13854

2. Lipton R. Depression and Anxiety Are Associated with Increased Headache-Related Disability in Episodic and Chronic Migraine: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Presented at: 2019 American Headache Society Annual Meeting. July 11-14, 2019; Philadelphia, PA. Poster P160.