Predictors of migraine headache recurrence

A pooled analysis from the eletriptan database

David W. Dodick, Richard B. Lipton, Peter J. Goadsby, Peer Tfelt-Hansen, Michel D. Ferrari, Hans Christoph Diener, Mary Almas, Kenneth S. Albert, Bruce Parsons

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective. - To identify clinical variables associated with risk of headache recurrence within 22 hours of initial successful treatment of a migraine attack (2-hour headache response), and to analyze the effect of eletriptan in reducing the incidence of recurrence. Methods. - Data were pooled from 10 randomized, double-blind, placebo-controlled trials evaluating eletriptan 40 mg (E40), eletriptan 80 mg (E80), and sumatriptan 100 mg (S100) for acute migraine treatment. Patients who achieved a headache response (improvement from moderate/severe pain at baseline to mild/no pain at 2 hours postdose) were evaluable. A multivariable logistic regression analysis identified significant predictors of headache recurrence (return to moderate/severe pain intensity within 22 hours of initial headache response). Treatment response was assessed in two high-risk subgroups, defined by the presence of significant recurrence predictors. Results. - Of 4312 patients responding to acute treatment within 2 hours postdose, 1232 (29%) experienced recurrence. Initial headache response within 2 hours was significantly higher for E40 (62.0%), E80 (67.4%), and S100 (57.9%) compared to placebo (25.1%; all P <.0001). Three clinical variables were significant predictors of recurrence: female gender, age ≥35 years, and severe baseline headache pain. Among patients with all 3 risk factors (n = 742; 17% of total population), recurrence rates were lower with E40 (35.6%) and E80 (32.9%) than placebo (47.8% P <.01). The same result was observed in the subgroup of patients with 2 risk factors (female gender and age ≥35 years; P <.0001 vs placebo). Sustained headache and pain-free response rates (a headache/pain-free response at 2 hours postdose with no headache recurrence and no rescue medication use in the subsequent 22 hours) were significantly higher with E40 and E80 than placebo in both high-risk subgroups (P <.05). Conclusion. - Female gender, age ≥35 years, and severe baseline headache pain are significant predictors of headache recurrence during a migraine attack. Eletriptan is effective at reducing the incidence of headache recurrence in high-risk subgroups.

Original languageEnglish (US)
Pages (from-to)184-193
Number of pages10
JournalHeadache
Volume48
Issue number2
DOIs
StatePublished - Feb 2008

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Migraine Disorders
Headache
Databases
Recurrence
Placebos
Pain
Sumatriptan
eletriptan
Incidence
Therapeutics
Logistic Models
Regression Analysis

Keywords

  • Eletriptan
  • Predictors
  • Recurrence

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Dodick, D. W., Lipton, R. B., Goadsby, P. J., Tfelt-Hansen, P., Ferrari, M. D., Diener, H. C., ... Parsons, B. (2008). Predictors of migraine headache recurrence: A pooled analysis from the eletriptan database. Headache, 48(2), 184-193. https://doi.org/10.1111/j.1526-4610.2007.00868.x

Predictors of migraine headache recurrence : A pooled analysis from the eletriptan database. / Dodick, David W.; Lipton, Richard B.; Goadsby, Peter J.; Tfelt-Hansen, Peer; Ferrari, Michel D.; Diener, Hans Christoph; Almas, Mary; Albert, Kenneth S.; Parsons, Bruce.

In: Headache, Vol. 48, No. 2, 02.2008, p. 184-193.

Research output: Contribution to journalArticle

Dodick, DW, Lipton, RB, Goadsby, PJ, Tfelt-Hansen, P, Ferrari, MD, Diener, HC, Almas, M, Albert, KS & Parsons, B 2008, 'Predictors of migraine headache recurrence: A pooled analysis from the eletriptan database', Headache, vol. 48, no. 2, pp. 184-193. https://doi.org/10.1111/j.1526-4610.2007.00868.x
Dodick, David W. ; Lipton, Richard B. ; Goadsby, Peter J. ; Tfelt-Hansen, Peer ; Ferrari, Michel D. ; Diener, Hans Christoph ; Almas, Mary ; Albert, Kenneth S. ; Parsons, Bruce. / Predictors of migraine headache recurrence : A pooled analysis from the eletriptan database. In: Headache. 2008 ; Vol. 48, No. 2. pp. 184-193.
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abstract = "Objective. - To identify clinical variables associated with risk of headache recurrence within 22 hours of initial successful treatment of a migraine attack (2-hour headache response), and to analyze the effect of eletriptan in reducing the incidence of recurrence. Methods. - Data were pooled from 10 randomized, double-blind, placebo-controlled trials evaluating eletriptan 40 mg (E40), eletriptan 80 mg (E80), and sumatriptan 100 mg (S100) for acute migraine treatment. Patients who achieved a headache response (improvement from moderate/severe pain at baseline to mild/no pain at 2 hours postdose) were evaluable. A multivariable logistic regression analysis identified significant predictors of headache recurrence (return to moderate/severe pain intensity within 22 hours of initial headache response). Treatment response was assessed in two high-risk subgroups, defined by the presence of significant recurrence predictors. Results. - Of 4312 patients responding to acute treatment within 2 hours postdose, 1232 (29{\%}) experienced recurrence. Initial headache response within 2 hours was significantly higher for E40 (62.0{\%}), E80 (67.4{\%}), and S100 (57.9{\%}) compared to placebo (25.1{\%}; all P <.0001). Three clinical variables were significant predictors of recurrence: female gender, age ≥35 years, and severe baseline headache pain. Among patients with all 3 risk factors (n = 742; 17{\%} of total population), recurrence rates were lower with E40 (35.6{\%}) and E80 (32.9{\%}) than placebo (47.8{\%} P <.01). The same result was observed in the subgroup of patients with 2 risk factors (female gender and age ≥35 years; P <.0001 vs placebo). Sustained headache and pain-free response rates (a headache/pain-free response at 2 hours postdose with no headache recurrence and no rescue medication use in the subsequent 22 hours) were significantly higher with E40 and E80 than placebo in both high-risk subgroups (P <.05). Conclusion. - Female gender, age ≥35 years, and severe baseline headache pain are significant predictors of headache recurrence during a migraine attack. Eletriptan is effective at reducing the incidence of headache recurrence in high-risk subgroups.",
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N2 - Objective. - To identify clinical variables associated with risk of headache recurrence within 22 hours of initial successful treatment of a migraine attack (2-hour headache response), and to analyze the effect of eletriptan in reducing the incidence of recurrence. Methods. - Data were pooled from 10 randomized, double-blind, placebo-controlled trials evaluating eletriptan 40 mg (E40), eletriptan 80 mg (E80), and sumatriptan 100 mg (S100) for acute migraine treatment. Patients who achieved a headache response (improvement from moderate/severe pain at baseline to mild/no pain at 2 hours postdose) were evaluable. A multivariable logistic regression analysis identified significant predictors of headache recurrence (return to moderate/severe pain intensity within 22 hours of initial headache response). Treatment response was assessed in two high-risk subgroups, defined by the presence of significant recurrence predictors. Results. - Of 4312 patients responding to acute treatment within 2 hours postdose, 1232 (29%) experienced recurrence. Initial headache response within 2 hours was significantly higher for E40 (62.0%), E80 (67.4%), and S100 (57.9%) compared to placebo (25.1%; all P <.0001). Three clinical variables were significant predictors of recurrence: female gender, age ≥35 years, and severe baseline headache pain. Among patients with all 3 risk factors (n = 742; 17% of total population), recurrence rates were lower with E40 (35.6%) and E80 (32.9%) than placebo (47.8% P <.01). The same result was observed in the subgroup of patients with 2 risk factors (female gender and age ≥35 years; P <.0001 vs placebo). Sustained headache and pain-free response rates (a headache/pain-free response at 2 hours postdose with no headache recurrence and no rescue medication use in the subsequent 22 hours) were significantly higher with E40 and E80 than placebo in both high-risk subgroups (P <.05). Conclusion. - Female gender, age ≥35 years, and severe baseline headache pain are significant predictors of headache recurrence during a migraine attack. Eletriptan is effective at reducing the incidence of headache recurrence in high-risk subgroups.

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