SAN FRANCISCO – People with migraines can be classified into eight clinically meaningful subgroups according to comorbidities, which can lead to headaches and lead to individualized treatment, researchers reported here.
A modeling analysis showed that comorbidity patterns were correlated with a series of headache functions. For example, people with respiratory and psychiatric comorbidities were probably aware of photophobia and phonophobia, while those with cardiovascular comorbidities were least likely to experience nausea associated with headaches, according to Richard Lipton, MD, of the Albert Einstein College of Medicine in New York City, and colleagues.
"We started with a series of questions," said Lipton during the Harold G. Wolff Prize Lecture at the American Headquarters Society (AHS) Annual Meeting. Why are migraines so common? Why are the clinical characteristics of migraines so varied from person to person? Why do some people respond well to preventive treatment but not another? Why do we need to work so hard to find the right treatment for our Why can we not find genes that account for most people with common forms of migraines? "
" The answer to all these questions is that migraine is really more than one thing. "Lipton continued." It is quite important to understand the heterogeneous nature of migraine and find methods to identify natural subgroups of people with migraines ̵
The analysis Based on data from CaMEO (Chronic Migraine Epidemiology and Outcomes), a prospective web-based survey that collected data on symptoms, treatment and quality of life from thousands of people with migraine in the United States
Of a total population of nearly 13,000 respondents, they were excluded as did not have any self-reported comorbidities, which triggered ov to a selection of 11,837 patients. The researchers initially looked at 62 comorbidities, but exclude those who were not useful to distinguish between groups and left 22.
After investigating a series of models, they found that a model with eight subgroups fits best in data. The researchers then decided on different comorbidities, symptoms and other headaches were more or less common than the average in each subgroup.
Each natural subgroup had a distinct profile of demographic characteristics and clinical characteristics varied across classes, Lipton reported. For example, the respiratory / psychiatric group included a higher proportion of women, the cardiovascular group included more men and the psychiatric group was the youngest.
Patients who had many comorbidities were more than four times more likely to have chronic migraines compared to humans in the low comorbidities group (23.1% to 4.8%). This group also had a high probability of experiencing aura, allodynia, moderate to severe intensity pain, nausea and impairment of pain with routine activities.
The respiratory / psychiatric group was most likely to report disturbing or disturbing headache and were most likely disturbed by light and sound. In contrast, the cardiovascular group was least likely to experience any of these symptoms.
Patients with many comorbidities were likely to have severe migraine related disabilities or MIDAS IV (48.1%) followed by respiratory / psychiatric (31.9%) respiratory / pain (28.6%) and psychiatric (26 , 1%) subgroups. Again, the cardiovascular group reported least severe disability (14.1%).
The researchers then asked whether these subcategories for comorbidity could be used to identify which patients were at greatest risk of progression from episodic migraine to chronic migraine.
If you want to understand the mechanism of something, it's very often useful to understand what it's co-located with, says AHS Scientific Program Committee Peter Goadsby, MD, Doctor, to journalists during a media briefing before the meeting.
"Those with family members with migraines, if I say to people with more comorbidities are more likely to develop, you may not be surprised. If you begin to understand the mechanisms of the interaction, you begin to understand better how people with rare Migraines develop frequent migraines, "he continued." If you understand how they get there, you can understand how to lead them back. "
After exclusion of people who already had chronic migraines at baseline, Lipton's group looked at an analytical sample of 8,658 patients.
Compared to low-comorbidity subset, those in the high-comorbidity group were 5.3 times more likely to develop new chronic migraine in one year after, adjusted for demographic factors, Lipton reported. When other migraine functions such as symptom and overdose of Drugs added to the model, weakened the effect (3.0 times more likely), but the subgroup comorbidity level still predicted the risk of progression.
"The hope is that when we identify biologically homogeneous groups, we will be able to do for a larger proportion of people with migraines what has been done to the family of hemiplegic migraines – that this work can help us predict predictions and treatment responses and ultimately maybe lead to more powerful clinical trials, "Lipton said.
"Currently, the drugs we discover are effective for large subgroups of migraines," he added. "If there was a treatment that works for 10% or 15% of migraines, how we do our trials right now, we would totally miss these effects."
These results represent a step towards more personalized treatment for people with migraines.
"We can see how this work can lead us to a time of precision medicine for migraines," said ASH session broker Todd Schwedt, MD, at the Mayo Clinic in Phoenix.
The CaMEO study was sponsored by Allergan.
Lipton revealed support from and relevant relationships with several companies including Allergan, Amgen, Biohaven, Dr. Reddy, Eli Lilly, GlaxoSmithKline, Merck and Teva.
2018-07-01T19: 40: 28-0400