AMPP Study Results: CVD Associated With Migraine; Migraineurs Still Not Receiving Optimal Treatment

Patients with migraine are more likely than nonmigraineurs to experience cardiovascular events, according to recent results of the American Migraine Prevalence and Prevention (AMPP) Study. In addition, migraine patients are often not receiving effective treatment, which affects their functioning and ability to work. Patients with chronic migraine (CM) were also shown to have lower rates of remission than other patients with headache. These results were presented at the 14th annual International Headache Congress in Philadelphia.¹

AMPP is a longitudinal, prospective study that began in 2004, when questionnaires were mailed to 120,000 households in the United States. Each year, researchers involved with the AMPP study have followed up with the 24,000 respondents who experience severe headaches. Active migraine was determined in respondents who had experienced at least 1 severe headache in the past year that met the International Classification of Headache Disorders, 2nd edition, criteria. Those whose symptoms matched the criteria were classified as having episodic migraine (EM) (fewer than 15 headache days each month) or CM (15 or more headache days each month). Richard Lipton, MD, a neurologist and migraine specialist with the Albert Einstein College of Medicine in New York, presented key points from the AMPP study. “The real strength of the AMPP study is that we have well-characterized phenotypes,” he said.

LINKS BETWEEN CARDIOVASCULAR DISEASE AND MIGRAINE
Migraine with aura tripled the odds of cardiovascular events overall, said Dr Lipton. Migraine without aura was also shown to be a risk factor for myocardial infarction and transient ischemic attack. Triptans and other treatments were not shown to increase the risk of cardiovascular events.²

ACUTE TREATMENT FOR MIGRAINE IS SUBOPTIMAL
Patients with migraine often use triptans in combination with other acute therapies, which led Dr Lipton’s team to conclude that triptan monotherapy may not be meeting the needs of patients seeking acute treatment of migraine. In addition, most patients with episodic migraine used more than 1 class of therapy for acute treatment. Patients using monotherapy were most likely to take an NSAID, but in general, patients most often relied on treatment from multiple classes of medications. This demonstrates that treatment needs of patients with migraine remain unmet.^3,4

IMPACT OF MIGRAINE ON EMPLOYMENT AND WORK
Patients with CM were shown to have significantly less productive time that those with EM. This suggests that the indirect costs associated with headache may underestimate the burden on those with CM. Results suggest that patients with high-frequency migraine should use preventive treatments.^5-7

RATES AND PREDICTORS OF MIGRAINE REMISSION
Study authors sought to determine rates of remission in patients with CM and identify predictors of remission for CM and EM. While most headache patients using prophylaxis were likely to have remission, only half of patients with CM had symptom remission.⁸

References:

References

1. Lipton RB. American Migraine Prevalence and Prevention Study (AMPP): What Have We Learned? Presented at: the International Headache Conference; September 12, 2009; Philadelphia.
2. Bigal ME, Santanello NC, Buse DC, et al. Migraine with and without aura are associated with cardiovascular disease. The American Migraine Prevalence and Prevention study. Presented at: the International Headache Conference; September 10-13, 2009; Philadelphia. Abstract.
3. Buse DC, Bigal ME, Serrano D, et al. Triptan use patterns among migraine sufferers: results of the American Migraine Prevalence and Prevention study (AMPP). Presented at: the International Headache Conference; September 10-13, 2009; Philadelphia. Abstract.
4. Lipton RB, Buse DC, Serrano D, et al. Acute medication use patterns in episodic migraine: results of the American Migraine Prevalence and Prevention study (AMPP). Presented at: the International Headache Conference; September 10-13, 2009; Philadelphia. Abstract.
5. Stewart WF, Woods GC, Manack A. Employment and work impact of headache among episodic and chronic migraine sufferers: results of the American Migraine Prevalence and Prevention (AMPP) Study. Presented at: the International Headache Conference; September 10-13, 2009; Philadelphia. Abstract.
6. Buse DC, Manack A, Serrano D, et al. Age-specific estimates of lost time due to headache in chronic migraine and episodic migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. Presented at: the International Headache Conference; September 10-13, 2009; Philadelphia. Abstract.
7. Lipton RB2, Manack A1, Buse DC, et al. Disability impact upon remission from chronic migraine to episodic migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. Presented at: the International Headache Conference; September 10-13, 2009; Philadelphia. Abstract.
8. Manack A, Buse DC, Serrano D, et al. Rates and predictors of remission from chronic migraine to episodic migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. Presented at: the International Headache Conference; September 10-13, 2009; Philadelphia. Abstract.