Environmental and psychological risk factors for migraine chronification in China: A multicenter prospective cohort study

BackgroundPreventing migraine chronification is a key treatment goal, yet environmental and lifestyle contributors remain understudied in Asian populations. We investigated predictors of the transition from episodic migraine (EM) to chronic migraine (CM) in a prospective Chinese clinical-based cohort.MethodsThis multicenter, prospective study involved 1642 participants with EM meeting ICHD-3 criteria. Baseline characteristics, including environmental factors and psychological scales, were captured via a Clinical Decision Support System (CDSS). Longitudinal follow-up was conducted using a web-based mini-program. Risk factors were identified using multi-variable Cox proportional hazards models, validated by LASSO and stepwise regression.ResultsDuring a median 6-month follow-up, 47 (2.9%) patients progressed to CM. Multivariable analysis identified anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7) score: Hazard Ratio (HR) 1.15, 95% Confidence Interval (CI) 1.06-1.25], baseline analgesic use frequency (HR 1.07, 95% CI 1.01-1.14), and age (HR 1.04, 95% CI 1.01-1.06) as independent risk factors. Conversely, weekly physical activity duration emerged as a significant protective factor (HR 0.66, 95% CI 0.45-0.98).ConclusionAnxiety and higher frequency of analgesic use are independent risk factors of migraine chronification in this Chinese cohort, while regular physical activity offers protection. These findings support an integrated management strategy combining psychological intervention, medication education, and exercise therapy.