The Profile and Prognosis of Youth With Status Migrainosus: Results From an Observational Study
Serena L. Orr, Abigail Norris Turner, Marielle A. Kabbouche, Paul S. Horn, Hope L. O’Brien, Joanne Kacperski, Susan L. LeCates, Shannon White, Jessica Weberding, Mimi N. Miller, Scott W. Powers, Andrew D. Hershey
Abstract
Objective To characterize the clinical features of a large sample of children, adolescents, and young adults with a history of status migrainosus (SM) and to describe their short‐term prognosis. Background Data on the clinical characteristics of children and adolescents with SM are sparse and little is known about the prognosis of this population. Methods This was a retrospective clinical cohort study that included patients from the Cincinnati Children’s Headache Center if they had a diagnosis of migraine and data available for a 1‐3 months follow‐up interval. Data extracted from the initial interval visit (visit A) included: age, sex, race, migraine diagnosis, SM history, chronic migraine, medication overuse headache (MOH), body mass index (BMI), headache frequency, headache severity, disability, allodynia and lifestyle habits: caffeine intake, meal skipping, sleep duration, exercise frequency, and fluid intake. Data extracted from the initial consultation visit included: months with headache at initial consultation visit, patient endorsing “feeling depressed” and anxiety symptoms. Headache frequency and visit type were also measured at the second visit (visit B) in the follow‐up interval. A multivariate logistic regression model with a backward elimination procedure was created to model the odds of having a diagnosis of SM using the cross‐sectional predictor variables above. Second, chi‐square tests were used to compare the proportion of patients with SM to the proportion of patients without SM who had each of the following outcomes in the short‐term follow‐up window: treatment response (50% or greater reduction in headache frequency), overall reduction in headache frequency (reduction of 1 or more headache days/month), minimal change in headache frequency (increase in 0‐3 headache days/month), and clinical worsening (increase in 4 or more headache days/month). Results A total of 5316 youth with migraine were included and 559 (10.5%) had a history of SM. In the multivariate logistic regression model, predictors significantly associated with SM were: older age (OR = 1.13, 95% CI = 1.09‐1.17, P < .0001), migraine with aura (MWA) (OR = 1.30, 95% CI = 1.03‐1.65, P = .03), MOH (OR = 1.72, 95% CI = 1.30‐2.28, P = .0001), headache frequency (OR = 0.99, 95% CI = 0.97‐0.99, P = .030), higher headache severity (OR = 1.08, 95% CI = 1.02‐1.15, P = .009), months with headache at initial consultation (OR = 1.00, 95% CI = 1.00‐1.01, P = .042), and admission to infusion center at visit B (OR = 2.27, 95% CI = 1.38‐3.72, P = .001). Patients with a history of SM were more likely to experience an increase in 4 or more headache days per month at follow‐up: 15.2% as compared to 11.1% of those without SM, χ 2 (1, n = 5316) = 8.172, P = .0043. Conclusions Youth with SM represent a distinct subgroup of the migraine population and have an unfavorable short‐term prognosis.