Profesionales médicos

Nov. 26, 2024

There currently is no way to predict whether a preventive medication for headaches will be helpful for specific patients. Using novel artificial intelligence techniques, Mayo Clinic researchers have developed effective tools that can predict patient response to seven different migraine-preventive medications before medication is started.

The researchers analyzed data collected from 4,260 Mayo Clinic patients from 2001 to 2023. The patients completed questionnaires at their initial headache consultations and at each follow-up visit. The detailed questionnaires recorded initial clinical features of the individuals' headaches and then tracked preventive medication changes and monthly headache days.

The researchers also trained a deep neural network to construct prediction models for each medication studied. A treatment responder was defined as having at least a 30% reduction in monthly headache days from baseline.

Key findings:

• The model can accurately predict whether a patient will respond to calcitonin gene-related peptide monoclonal antibody medications, also called CGRP mAbs.
• The model performance for other medications was less impressive but similar to that of machine learning models reported for other diseases.

The most important variables across all prediction models were:

• Baseline number of monthly headache days.
• Age.
• Body mass index (BMI).
• Duration of migraine attack.
• Responses to previous medication trials.
• Cranial autonomic symptoms.
• Family history of headaches.
• Migraine attack triggers.

"Our study found that the ways in which patients describe their headaches, and the types of symptoms they have, is important in predicting whether a medication will work," says Chia-Chung Chiang, M.D., a headache specialist and vascular neurologist at Mayo Clinic in Rochester, Minnesota, and the study's lead author.

She notes that the variables contributed differently to the accuracy of the seven models. "For example, lower BMI predicts responsiveness to CGRP mAbs and beta blockers, while higher BMI predicts responsiveness to onabotulinumtoxinA, topiramate and gabapentin," Dr. Chiang says. "Our results suggest that precision migraine treatment is feasible."

For more information

Chiang CC, et al. Advancing toward precision migraine treatment: Predicting responses to preventive medications with machine learning models based on patient and migraine features. Headache. 2024;64:1094.

Refer a patient to Mayo Clinic.