Refining the definition of severe migraine: Evidence from a prospective observational study.

INTRODUCTION

Migraine severity is often assessed by attack frequency, but this single dimension fails to reflect the full burden of disease. We aimed to validate a pragmatic multidimensional definition of severe migraine in a tertiary care setting.

METHODS

We conducted an observational study including 96 consecutive adult migraine patients diagnosed according to ICHD-3 criteria at a tertiary pain center (Marseille, January-April 2024). Data collected included migraine days/month, HIT-6, MIGSEV, and HAD scores. Patients were categorized by frequency (<8 vs. ≥8days/month), HIT-6 (<60, 60-64,≥65), and MIGSEV grades (1-3).

RESULTS

Median monthly frequency was 8days. Patients with≥8days/month had significantly higher HIT-6 scores (P=0.044). Among patients with<8days/month, both HIT-6≥65 and MIGSEV grade 3 identified individuals with greater functional disability and higher depressive symptoms, comparable to those in the high-frequency group. No demographic or comorbidity variables significantly distinguished severe cases.

DISCUSSION: A multidimensional definition of severe migraine is supported: (A)≥8days/month, or (B)<8days/month with HIT-6≥65 and/or MIGSEV grade 3. This definition integrates frequency, functional impact, and perceived severity, providing a simple and reproducible framework to identify high-burden patients. It may improve preventive treatment decisions, referral to specialized care, and harmonization of research inclusion criteria.