From transformed migraine to episodic migraine: reversion factors

OBJECTIVE: To identify the factors contributing to the reversion of transformed migraine (TM) into episodic migraine. BACKGROUND: TM, the most common and important subtype of chronic daily headache (CDH), has a great effect on a patient's quality of life. However, its clinical course and outcome predictors have rarely been studied prospectively. METHOD: Of 1142 consecutive headache patients seen at the Headache Clinic of the Samsung Medical Center, the patients with TM (frequency >15/month for >6 months and a history of migraine meeting the ICHD-II diagnostic criteria) were followed for at least 1 year. We analyzed the demographic data, clinical course, and compliance factors, such as those of the physician's management protocol and recommended lifestyle modification. RESULTS: A total of 136 patients finished the final follow-up assessment 1 year after the initial evaluation. Ninety-five patients (70%) converted from TM to episodic migraine. Forty-one patients (30%) continued to suffer daily headaches without a period of improvement. The demographic and clinical information collected before the treatment was not significantly related to outcome, except for chronic use of analgesics for other medical conditions (P= .01). Of the compliance factors, good compliance with preventive medication (P < .001), withdrawal from continuous use of analgesics for headache relief (P < .001), and regular exercise (P= .04) were significant positive contributors to the reversion of TM into episodic migraine. CONCLUSION: Compliance factors are the most important factors that determine the reversion of TM into episodic migraine.