Is migraine a spectrum disorder? Questioning the concept of "episodic" and "chronic" migraine using population-based data from 10,226 adults with migraine from 14 countries
Abstract
Background: The first edition of the International Classification of Headache Disorders (ICHD-I) did not recognize chronic migraine (CM). ICHD-II introduced CM as a complication of migraine, with criteria that were widely criticized and later revised to require ≥ 15 monthly headache days (MHDs) with ≥ 8 monthly migraine days (MMDs). ICHD-3 reclassified CM as a type distinct from episodic migraine, retaining these frequency thresholds but without empirical justification. We investigated whether population-based evidence on headache characteristics and burden supported distinction between episodic and chronic migraine types, or indicated that migraine was better conceptualized as a single disorder expressed along a frequency spectrum.
Methods: We performed a meta-analysis of individual participant data from 15 cross-sectional population-based surveys from the Global Campaign against Headache, all randomly selecting adults (18-65 years) and using the HARDSHIP questionnaire for data collection. Diagnoses made algorithmically observed the hierarchical order of ICHD. We identified four migraine groups: (1) migraine (definite+probable) including, and (2) migraine (definite+probable) excluding those with concomitant probable medication-overuse headache (pMOH); (3) migraine (definite only) including, and (4) migraine (definite only) excluding those with concomitant pMOH. MMDs and MHDs were regressed against headache characteristics, quality of life (QoL) and impaired participation.…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 36,407 participants or records.
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