Data Reveal Predictors of Transformation From Episodic to Chronic Migraine

January 15, 2020
Gianna Melillo

Gianna is an associate editor of The American Journal of Managed Care® (AJMC®). She has been working on AJMC® since 2019 and has a BA in philosophy and journalism & professional writing from The College of New Jersey.

A systematic review and meta-analysis of data collected from observational cohort studies reveals several clinical and sociodemographic factors are predictors of chronic migraine.

A systematic review and meta-analysis of data collected from observational cohort studies reveals several clinical and sociodemographic factors are predictors of chronic migraine.

The study, published in the International Headache Society’s Cephalalgia, looked at results of 11 prospective cohort studies that reported risk factors among patients suffering from episodic migraine. These risk factors were categorized as predictors of transformation from episodic migraine to chronic migraine. The 11 studies took place between 2004 and 2008 and covered 65,775 subjects. Both qualitative and quantitative analytic approaches were included in the review.

According to the authors, “An estimated 2.5% to 3.1% of people with episodic migraine develop chronic migraine” each year.

Individuals suffering from chronic migraine tend to have lower annual incomes, are less likely to have a full-time job, exhibit more comorbidities, and are more likely to have occupational disabilities compared with those with episodic migraine.

The pooled analysis of a fixed-effect model found "high evidence" for monthly headache day frequency ≥10 (risk ratio [RR], 5.95; 95% CI, 4.75-7.46) and "moderate evidence" for depression (assessed by the Patient Health Questionnaire-9) (RR, 1.58; 95% CI, 1.35-1.85), monthly headache day frequency ≥5 (RR, 3.18; 95% CI, 2.65-3.82), and annual household income ≥$50,000 (RR, 0.65; 95%CI, 0.54-0.79) as predictors.

The analysis found "very low" evidence for cutaneous allodynia (RR, 1.40; 95% CI, 1.23-1.59) and medication overuse (RR, 8.82), although both slightly increased the risk of new onset chronic migraine,

Specifically, for the first time, they reported that “episodic migraine patients with monthly headache day frequency ≥10 had a greater risk than monthly headache day frequency ≥5 in transformation to chronic migraine.”

By identifying risk factors of the development of chronic migraine, the researchers hope to better understand the natural course of the disorder, in order to assist in selecting or designing interventions.

Other reported risk factors or predictors of chronic migraine in the selected studies included sex, body mass index, migraine symptom severity score, family headache history, and asthma.

"Depression is one of the most frequently reported risk factors associated with chronic migraine onset across the different research designs…We found that currently meeting criteria for depression as assessed with the Patient Health Questionnaire-9 was associated with a 54% increase in relative risk of new onset chronic migraine,” the authors noted.

In addition, data showed “strong evidence” that an increase in frequency of headache days per month was associated with a higher risk of transformation.

Cutaneous allodynia and medication overuse have been associated with increased risk of chronic migraine in previous studies, but the authors note their lack of substantial conclusions relating to these factors may be due to “limited published data meeting our inclusion criteria.”

When it comes to income, “It is likely that individuals with higher incomes have greater access to healthcare and treatment of migraine as well as other comorbidities, psychological conditions, and healthy lifestyle practices,” they said.


Xu J, Kong F, Buse DC. Predictors of episodic migraine transformation to chronic migraine: a systematic review and meta-analysis of observational cohort studies [published online October 21, 2019]. Cephalalgia. doi: 10.1177/0333102419883355.