Pain and Headache

Chronic Migraine

Chronic migraine refers to migraine headaches occurring at least 15 days per month, frequently associated with significant functional impairment and depression.

Outcomes of Treatment in Chronic Migraine Patients (N = 92)

2017 - 2018

HIT-6 = Headache Impact Test, PDI = Pain Disability Index, PHQ-9 = Patient Health Questionnaire, PROMIS = Patient Reported Outcome Measurement Information System

The median interval between initial appointment and follow-up was 185 days (range, 143–598). Of the 72 patients who reported HIT-6 scores > 50 at initial evaluation (higher scores indicate greater impairment secondary to headache pain¹), 29% reported improvement. Of the 37 patients who reported initial PDI scores ≥ 20 (higher scores indicate greater disability), 41% reported improvement at follow-up. Clinically meaningful change was defined as ≥ 9 points.² Of the 33 patients who reported initial PROMIS³ pain at or above the median score of 6, 97% improved or remained stable. Of the 33 patients who reported initial depressive symptoms ≥ 10 points for the PHQ-9 (higher scores indicate greater depression⁴), 45% reported improvement at follow-up.

References
  1. Coeytaux RR, Kaufman JS, Chao R, Mann JD, Devellis RF. Four methods of estimating the minimal important difference score were compared to establish a clinically significant change in Headache Impact Test. J Clin Epidemiol. 2006 Apr;59(4):374-380.
  2. Soer R, Reneman MF, Vroomen PC, Stegeman P, Coppes MH. Responsiveness and minimally clinically important change of the Pain Disability Index in patients with chronic back pain. Spine, 2012 Apr 15;37(8):711-715.
  3. Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res. 2009 Sep;18(7):873-880.
  4. Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Med Care. 2004 Dec;42(12):1194-1201.