Using the CaMEO study, we evaluated 2 different definitions of migraine disease progression, based on changes in either monthly headache days (MHDs) or in Migraine Disability Assessment Scale (MIDAS) scores.

Migraine progression is typically defined by the episodic (EM) to chronic migraine (CM) transition, precluding progression of CM. Based on this definition, approximately 3% of individuals with migraine transition each year from episodic migraine (EM; defined as <15 MHDs to CM; defined as ≥15 or more MHDs).

The CaMEO Study (NCT01648530) was a longitudinal web-based survey, evaluating migraine disease state every 3 months for up to 1 year in a representative sample of people with migraine (US population). Eligible respondents met an ICHD-3 definition for CM at baseline and provided assessments at baseline, 3, 6, 9 and/or 12 months. Disease progression was defined as an increase of ≥5 MHDs or ≥5 MIDAS points from baseline to any follow-up timepoint; persistence required maintaining progression at subsequent timepoints for ≥6 months. External validators included the Migraine Specific Quality of Life Questionnaire (MSQv2.1), a depression screener (PHQ-9), and an anxiety screener (GAD-7).

342 eligible respondents with CM had a baseline median of 19.3 (Q1-15.9, Q3-21.7) MHDs and a median MIDAS score of 30.0 (Q1-13, Q3-65). 16.4% (n=56) of respondents progressed based on an increase of ≥5 MHDs, and 27.2% (n=93) based on an increase of ≥5 MIDAS points. In total, 34.5% (n=118) of respondents progressed and 7.3% (n=25) progressed and persisted based on ≥1 of these 2 disease progression definitions. The subgroup with disease progression demonstrated lower quality of life on MSQv.2.1 and higher rates of depression (PHQ-9) and anxiety symptoms (GAD-7).

CM is a sometimes-progressive disorder. Novel definitions of progression characterize the disease state dynamics of people with CM, underscoring the need for CM treatment optimization.