Exacerbation of headache during dihydroergotamine for chronic migraine does not alter outcome.

Eller, Michael; Gelfand, Amy A; Riggins, Nina Y; Shiboski, Stephen; Schankin, Christoph; Goadsby, Peter J (2016). Exacerbation of headache during dihydroergotamine for chronic migraine does not alter outcome. Neurology, 86(9), pp. 856-859. Lippincott Williams & Wilkins 10.1212/WNL.0000000000002406

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OBJECTIVE To evaluate whether headache exacerbation associated with IV dihydroergotamine (DHE) infusion predicts medium-term headache outcome in patients with chronic migraine. METHODS This was a retrospective chart review study of the UCSF Headache Center's use of IV DHE for chronic migraine from 2008 to 2012. Medium-term headache outcome was assessed at 6-week follow-up. Univariate and multivariate logistic regression models were used to assess for predictors of outcome. RESULTS Patients with chronic migraine (n = 274) were treated with a course of IV DHE. Of 214 with 6-week follow-up, 78% had medium-term headache benefit. In a univariate logistic regression model, headache exacerbation with DHE was associated with lower odds of a positive medium-term headache outcome (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.20-0.91). However, in the multivariate logistic regression model, headache exacerbation was no longer an independent predictor of treatment outcome (OR 0.65, 95% CI 0.28-1.51). Factors that independently predicted outcome were nausea (OR 0.12, 95% CI 0.02-1.00, p = 0.05), age (OR 1.68 for each decade increase in age, 95% CI 1.24-2.28), and medication overuse (OR 0.42, 95% CI 0.18-0.97). CONCLUSIONS After controlling for nausea and other factors, headache exacerbation with DHE infusions is not an independent predictor of poor headache outcome and clinicians should not interpret its presence as a reason to stop treatment. The focus of management should be on controlling nausea as it is the most important modifiable factor in achieving a good headache outcome with an inpatient course of IV DHE for chronic migraine.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Schankin, Christoph

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0028-3878

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

16 Sep 2016 09:08

Last Modified:

16 Sep 2016 09:08

Publisher DOI:

10.1212/WNL.0000000000002406

PubMed ID:

26843569

BORIS DOI:

10.7892/boris.87805

URI:

https://boris.unibe.ch/id/eprint/87805

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