Survival outcome and mortality rate in patients with migraine: a population- based cohort study

DOI: https://doi.org/10.1186/s10194- 018- 0889- 4

Abstract-Summary Whether the patients with migraine have an elevated mortality risk in Taiwan is unclear.

Compared with the comparison cohort, the corresponding aHRs for mortality were 0.81 (95% CI  =  0.76–0.87), 0.89 (95% CI  =  0.80–0.98), and 0.78 (95% CI = 0.72–0.84) in the total migraine, SM, and NM cohorts, respectively.

SM, male sex, comorbid alcohol-related illness, depression, and mental disor-

ders were identified as risk factors for subsequent mortality.

Comorbid alcohol-related illness significantly increased the mortality risk in

patients with migraine.

These patients would benefit from controlling their migraines and reducing the

subsequent mortality.

Extended: Compared with the comparison cohort, the corresponding adjusted HRs (aHRs; 95% CIs) of the mortality were 0.81 (0.76–0.87), 0.89 (0.80–0.98), and 0.78 (0.72–0.84) for the total migraine, SM, and NM cohorts, respectively.

Compared with the comparison cohort, the average hospitalization duration was

0.66 days longer for the patients ever with SM.

The findings of this study might constructively inform the development and implementation of effective treatment strategies to reduce the migraine burden in Taiwan.

The diagnoses of SM and NM in this study were highly reliable and our results indicate that the sample size was sufficient to statistically demonstrate the mortality risk in patients with migraine in Taiwan.

Our findings provide vital information for clinicians and for assisting global

efforts for understanding and treating migraine.

Background Numerous epidemiological studies conducted in developed Western countries have found that migraines affect approximately 20% of the general population [103, 104]. Researchers have proposed that patients with migraine have a higher risk of mor-

tality due to a high vulnerability to other fatal diseases.

Although numerous studies have examined the markers for the long-term out- comes of migraine, the actual mortality risk in patients with migraine has remained unclear so far [105–107].

Further investigation is required to understand the correlated mortality in patients

with migraine to elucidate future treatment strategies for migraine.

Patients with such a condition may experience considerably more disability than patients with a classic, non-status migraine (NM) and thus may require specific pharmacological treatment or adopt psychological strategies to reduce the burden of the disease [108].

1.1

Epidemiology

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Methods This population-based cohort study used the Longitudinal Health Insurance Database (LHID) provided by the National Health Research Institutes in Taiwan.

The comparison cohort comprised patients without a migraine diagnosis in

the LHID.

For each identified patient with migraine, 4 non-migraine participants from the LHID were randomly selected for the comparison cohort and were frequency matched with age (each 5-year span); sex; and comorbidities of depression (ICD-9-CM 296.2, 296.3, 296.82, 300.4, and 311), mental disorders (ICD-9-CM 290–319), insomnia (ICD-9-CM 307.4 and 780.5), alcohol-related illness (ICD-9-CM 291, 303, 305.00, 305.01, 305.02, 305.03, 571.0, 571.1, 571.3, 790.3, and V11.3), and anxiety (ICD-9-CM 300.00); and index date (year).

Univariable and multivariable Cox proportional hazard regression analyses were used to assess the risk of mortality associated with migraine compared with the comparison cohort.

Results Compared with the comparison cohort, the corresponding adjusted HRs (aHRs; 95% CIs) of the mortality were 0.81 (0.76–0.87), 0.89 (0.80–0.98), and 0.78 (0.72–0.84) for the total migraine, SM, and NM cohorts, respectively.

The aHRs of mortality were 0.68–0.86 and 0.64–0.84 in the total migraine and

NM cohorts, respectively.

Discussion To the risk factors of age and the condition of SM, alcohol-related illness, male sex, depression, and mental disorders were major risk factors for all-cause hospitaliza- tion and mortality in patients with migraine.

Among the comorbidities, alcohol-related illness was the strongest risk factor for

hospital admission and mortality in patients with migraine.

To cardiovascular risk, this study reveals that alcohol-related illness is another

risk factor to cause premature mortality in Taiwanese patients with migraine.

We only analyzed the mortality risks in patients with migraine who died after

being treated at inpatient facilities, excluding mortality cases outside a hospital.

The diagnoses of SM and NM in this study were highly reliable and our results indicate that the sample size was sufficient to statistically demonstrate the mortality risk in patients with migraine in Taiwan.

Conclusions This study revealed that Taiwanese patients with migraine benefit from comprehen- sive and universal health care for not only controlling their migraines but also reduc- ing subsequent mortality risk.

Our findings provide vital information for clinicians and for assisting global

efforts for understanding and treating migraine.

Acknowledgement A machine generated summary based on the work of Harnod, Tomor; Lin, Cheng-Li; Kao, Chia-Hung. 2018 in The Journal of Headache and Pain.

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1 Public Health

Major sex differences in migraine prevalence among occupational categories: a cross-sectional study using UK Biobank