Six-Month Changes in Migraine and Non-Migraine Headaches

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The intensity, frequency, associations of non-improvement, and daily inference of headaches is examined over a 6 month period.

The frequency, intensity, and daily interference of headaches do not remain constant. Rather, these factors change over a 6-month period, with day-to-day variation being more volatile in migraine than in non-migraine headaches, according to a new longitudinal study published in Cephalalgia.

Australian investigators examined prospectively the 6-month course of headaches in 79 participants with migraine (n=37) or tension-type or cervicogenic headache (n=42).

At baseline, participants underwent physical examination for cervical musculoskeletal impairments. At baseline and at follow-up, they also completed questionnaires on pain, disability, and other self-report measures, and kept an electronic diary for 6 months.

In both groups of participants, headache frequency, intensity, and activity interference were generally stable over the 6 months, although they did show some month-to-month variations. However, day-to-day variations were more volatile in the migraine than in the non-migraine group, with the highest probability of transitioning from any headache state to no headache (probability = 0.82-0.85).

The odds of non-improvement in those with disability were close to 6 times higher in participants with cervical joint dysfunction (odds ratio 5.58; 95% CI,1.14-27.42).

The study presents, “preliminary evidence that factors influencing non-improvement in disability in 6 months include headache features, cervical joint dysfunction, disability, and physical activity,” the investigators stated.

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They noted that their findings can “inform headache management” because information about the month-to-month and day-to-day variation in features of migraine and non-migraine headaches “can form part of patient education.” In particular, educating patients about the “most likely behavior of their headache” will not only help them “align their expectations,” but can also “be reassuring for patients who perceive the unpredictability of their headaches as disabling and disquieting.”

Additionally, the results “carry implications for outcome measure selection in prospective clinical trials,” they concluded.


Aguila MR, Rebbeck T, Pope A, Ng K, Leaver AM. Six-month clinical course and factors associated with non-improvement in migraine and non-migraine headaches [published online January 1, 2018]. Cephalalgia. doi:10.1177/0333102417744360