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 = 347)

2016 – 2017

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

In 2016 and 2017, 347 patients with chronic headaches were seen in the Center for Headache and Facial Pain, with a median interval between initial appointment and follow-up of approximately 181 days (range, 33–501). Of the 307 patients who reported Headache Impact Test scores > 50 at initial evaluation (higher scores indicate greater impairment secondary to headache pain¹), approximately 25% reported improvement. Of the 301 patients who reported initial Pain Disability Index scores ≥ 20 (higher scores indicate greater disability), > 30% reported improvement at follow-up. Clinically meaningful change was defined as ≥ 9 points.² The Patient Reported Outcome Measurement Information System is a self-reported measure of physical and emotional health status reflecting health-related quality of life.³ Of the 217 patients who reported initial quality of life > 0.5 SD below the mean, more than 20% reported improvement. Of the 158 patients who reported initial depressive symptoms above the cutoff of ≥ 10 points for the Patient Health Questionnaire (higher scores indicate greater depression⁴), approximately 30% 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.