AAN 2019 Annual Meeting Coverage
During the Comprehensive Migraine Update I course at the AAN 2019 Annual Meeting in Philadelphia, Prof. Richard B. Lipton (Montefiore Headache Center, New York City) gave a lecture on Migraine Comorbidities and Implications for Neurobiology. Prof. Lipton started by explaining the relevance of comorbidities in patients with migraine. Indeed, he argued that comorbidities may not only complicate diagnosis, but also inform and limit treatment options. Prof. Lipton further stated that comorbidities help to predict prognosis and contribute to the already high disease burden of migraine.
Prof. Lipton described a methodology to identify natural comorbidity subgroups of patients with migraine using Latent Class Analysis (LCA). This approach was applied to respondents of the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a web panel study that screened a demographically representative sample of patients with migraine who were followed up every 3 months for 15 months. The eligible sample for LCA included 11,837 patients with migraine and at least one comorbidity.1 Prof. Lipton showed that the best fitting model included eight classes of comorbidities: Most Comorbidities; Respiratory/Psychiatric; Respiratory/Pain; Respiratory; Psychiatric; Cardiovascular; Pain; and Fewest Comorbidities.
According to Prof. Lipton, each natural subgroup had a distinct profile of demographic characteristics, and clinical characteristics varied across the classes. For example, patients with respiratory/pain comorbidities tended to be older on average and those with many comorbidities were more likely to suffer from chronic migraine.1
Presenting his most recent unpublished research on comorbidities, Prof. Lipton found that the risk of migraine progression from episodic to chronic migraine is associated with all LCA-derived comorbidity classes when compared with the Fewest Comorbidities class. In Prof. Lipton’s opinion, this suggests that there are underlying biologic or genetic similarities linking members of each comorbidity subgroup. In conclusion, Prof. Lipton predicted that the LCA approaches he described could be successfully applied to many other disorders, such as cluster headache, epilepsy, cognitive aging and dementia, and multiple sclerosis.
Lipton RB, et al. Identifying natural subgroups of migraine based on comorbidity and concomitant condition profiles: Results of the chronic migraine epidemiology and outcomes (CaMEO) study. Headache. 2018;58:933-947.