ALL_30096 Botox CaMEO

The CaMEO study tracked the impact of chronic and episodic migraine on patients2 The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a US-based, cross-sectional and longitudinal internet study run by Allergan to track the epidemiology of migraine and its impact on patients.2 The CaMEO study was designed to characterise the course of chronic and episodic migraine.2

The CaMEO study was run by Allergan; committed to migraine research since the 1990s13,14 Allergan is committed to understanding migraine and how best to manage it.

As a company, we have dedicated over two decades to researching migraine, advancing patient care, and working closely with headache experts to enhance learning and expertise in this complex disease area.13–21

Self-reported outcomes from a web-based panel of almost 17,000 people were compiled over the course of one year, with the aim of enhancing understanding of subject-specific variations in migraine attack frequency, associated disability, psychiatric comorbidities, and the treatment journey.2 A series of cross-sectional modules also assessed previously unexplored aspects of barriers to care, comorbidities, and family burden of migraine among those with chronic migraine and episodic migraine.2 Date of preparation: March 2019 ND/0120/2019

Strandbergsgatan 61, 112 51 Stockholm Telefon: +46 (0)8 594 100 00, www.allergan.com

References 1.

Hoffmann J, et al. CNS Drugs. 2014;28(1):11–17.

2.

Adams AM, et al. Cephalalgia. 2015;35(7):563–578.

3.

Chaushev N, et al. J Clin Med. 2009;2(3):26–31.

4.

Burstein, R et al. J Neurosci. 2015;35(17):6619–6629.

5.

Buse DC, et al. Headache 2012;52:1456–1470.

6.

Agosti R. Headache 2018;58:17–32.

7.

WHO. The global burden of disease: 2004 update. Available at: http://www.who.int/ healthinfo/global_burden_disease/2004_report_update/en/. Accessed September 2018.

8.

Buse DC, et al. J Neurol Neurosurg Psych. 2010;81(4):428–432.

9.

The International Classification of Headache Disorders, 3rd edition. Cephalalgia.

2018;38(1):1–211.

10.

Buse DC, et al. Presented at the American Headache Society (AHS) 59th Annual Scientific Meeting 2017, 8–11 June; Boston, MA, USA. Poster PF16.

11.

Buse DC, et al. Presented at the American Association of Neurology (AAN) 68th Annual Meeting 2016, 15–21 April; Vancouver, Canada. Poster #121.

12.

Dodick DW, et al. Headache. 2016;56:821–834.

13.

Binder W, et al. Mov Disord. 1998;13:241.

14.

Relja MA, et al. Neurology. 1999;52 (Suppl 2):A203 P03.035.

15.

Zwart JA, et al. Headache. 1994;34(8):458–462.

16.

Silberstein S, et al. Headache. 2000;40(6):445–450.

17.

Binder W, et al. Otolaryngol Head Neck Surg. 2000;123(6):669–676.

18.

Mathew NT, et al. Headache. 2005;45(4):293–307.

19.

Dodick DW, et al. Headache. 2005;45(4):315–324.

20.

Aurora SK, et al. Cephalalgia. 2010;30(7):793–803.

21.

Diener HC, et al. Cephalalgia. 2010;30(7):804–814.

Migraine can be highly disabling for patients1 especially chronic migraine2 Results from CaMEO 2 – a study

by Allergan, committed to understanding migraine

CaMEO: The Chronic Migraine Epidemiology and Outcomes Study2

Produced and funded by Allergan

Migraine can have a devastating effect on patients2,3

Migraine is a common and disabling disorder defined by neurological symptoms such as headache pain, sensitivity to light and sound, and nausea.4

Headache disorders like migraine are associated with high levels of disability and socioeconomic costs.6 The World Health Organization (WHO) ranks severe migraine attacks in disability class VII, comparable to active psychosis, dementia and quadriplegia.7

Severe Migraine¥ severe depression, quadriplegia, terminal stage cancer

WHO disability classes from the Global Burden of Disease 2004 updatea7 1.0 0.9

Severity weightsb

Migraine is differentiated into two major subtypes based on headache attack frequency; episodic migraine and chronic migraine.5

Patients with chronic migraine face distinct challenges8

0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1

Stunting due to malnutrition, schistosomiasis infection*

Amputated finger, asthma case†

Angina, HIV not progressed to AIDS‡

Amputated arm, congestive heart failure$

Bipolar affective disorder, mild mental retardation‖

Blindness, Down syndrome¶

0.0 Disability class I

Disability class II

Disability class III

Disability class IV

Disability class V

Disability class VI

Disability class VII

Chronic migraine and episodic migraine are part of the spectrum of migraine disease, but they are distinct clinical entities.5 Many of the psychiatric co-morbidities (e.g. depression and anxiety) and cardiovascular comorbidities (such as stroke and coronary heart disease) associated with migraine have a greater relative frequency in chronic migraine (≥15 headache days/month for >3 months) than in episodic migraine (<15 headache days/month).8

ICHD-3 diagnostic criteria for chronic migraine9

A

Headache (migraine-like or tension-type-like) on ≥15 days/month for >3 months and fulfilling criteria B and C

B

Occuring in a patient who has had at least 5 attacks fulfilling criteria B–D for migraine without aura and/or criteria B–C for migraine with aura

C

On 8 days/month for >3 months, fulfilling any of the following:

1. Criteria C and D for migraine without aura

2. Criteria B and C for migraine with aura

3. Believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative

D

Not better accounted for by another ICHD-3 diagnosis

Notes a Conditions are listed in the disability class for their global average weight. Most conditions have distributions of severity spanning more than one disability class, potentially up to all seven. b Based on average severity weight globally for both sexes and all ages in the Global Burden of Disease 2004 update.

* Also, long-term scarring due to burns (less than 20% of body). † Also, edentulism, mastectomy, severe anaemia, stress incontinence. ‡ Also, infertility, alcohol dependence and problem use, low vision (<6/16 >3/60), rheumatoid arthritis. $ Also, deafness, drug dependence, Parkinsons disease, tuberculosis.

‖ Also, neurological sequelae of malaria, recto-vaginal fistula. ¶ Also, AIDS cases not on antiretroviral drugs, Alzheimer and other dementias. ¥ Also active psychosis, definition of severe migraine is not delineated in publication, note this may be a subset of total migraine population.

Adapted from: WHO. The Global Burden of Disease: 2004 update.7

CaMEO showed that migraine can be disabling, especially chronic migraine2,10–12 How chronic migraine affects patients:

How chronic migraine affects patients’ families:

Disability

Psychiatric co-morbidities

Sleep issues

times greater rate of disability days per month for people with chronic migraine vs. those with episodic migraine (based on MIDAS scores)2

of people with chronic migraine have depression and 48.4% have anxiety* (vs. 30% depression and 28.1% anxiety for people with episodic migraine)2

of people with chronic migraine are at an increased risk of sleep apnoea† with 44.1% having somnolence‡ (vs. 35.6% increased risk of sleep apnoea and 32.2% somnolence for people with episodic migraine)10

3.63

56.6%

Effects on adolescent children of patients

48.2%

of adolescents who have a parent with chronic migraine can’t get the help they need on at least one occasion over 30 days§ (vs. 26.4% who have a parent with episodic migraine)11

44.4%

of adolescents who have a parent with chronic migraine miss a family outing on at least one occasion over 30 days§ (vs. 22.3% who have a parent with episodic migraine)11

51.8% 44.4%

of adolescents who have a parent with chronic migraine missed having friends over to visit on at least one occasion over 30 daysǁ (vs. 21.5% who have a parent with episodic migraine)11

* Depression: chronic migraine, 56.6% n=836; episodic migraine, 30.0% n=4,589; p<0.001 (scored using the PHQ-9). Generalised anxiety disorder: chronic migraine, 48.4% n=715; episodic migraine, 28.1% n=4,307; p<0.001 (measured using GAD-7).2 † Chronic migraine, 51.8% n=575; episodic migraine, 35.6% n=4,164; p<0.001. Based on the Berlin Questionnaire for Sleep Apnoea, which classifies respondents as high risk or low risk based on their responses.10 ‡ Commonly experienced mean Medical Outcomes Study (MOS) dimension and index component values that differed between chronic migraine and episodic migraine included somnolence: chronic migraine, 44.1% n=490; episodic migraine, 32.2% n=3,767; p<0.001.10 § Over 30 days, 48.2% (n=79) of adolescents couldn’t get the help they needed on at least one occasion from a parent with chronic migraine vs. 26.4% (n=325) from a parent with episodic migraine (p<0.001); Over 30 days, 44.4% (n=63) of adolescents who have a parent with chronic migraine missed a family outing vs. 22.3% (n=255) who have a parent with episodic migraine (p<0.001).11 ǁ Over 30 days, 44.4% (n=68) of adolescents who have a parent with chronic migraine missed having a friend over to visit at their house vs. 21.5% (n=254) who have a parent with episodic migraine (p<0.001).11 1.

ICHD-3, International Classification of Headache Disorders (3rd edition).9

MIDAS, Migraine Disability Assessment.