63 Defining migraine days 3 A triptan was considered effective if the headache was reduced from moderate or severe to mild or no-pain within 2 hours post-dose. We chose triptans as no other acute migraine-specific medications were used at that time in the Netherlands (no ergotamine, no ditans nor gepants). Table 1. Definitions of a migraine day. Criteria for a migraine day A. Based on migraine characteristics with duration of headache of at least 4 hours (a) Headache duration ≥ 4 hours (b) Matching at least two of the following four characteristics: • unilateral; • pulsating; • moderate to severe pain; • aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs) (c) During headache at least one of the following: • nausea and/or vomiting; • photophobia and phonophobia OR (d) (Visual) aura duration 5-60 minutes B. Based on migraine characteristics with duration of headache of at least 30 minutes (a) Headache duration ≥ 30 minutes (b) Matching at least two of the following four characteristics: • unilateral; • pulsating; • moderate to severe pain; • aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs) (c) During headache at least one of the following: • nausea and/or vomiting; • photophobia and phonophobia OR (d) (Visual) aura duration 5-60 minutes C. Based on acute migraine-specific medication intake (a) A day with headache (b) Use of a triptan, ergotamine or other acute migraine-specific medication (e.g. ditans/gepants) D. Based on effective acute migraine-specific medication intake (a) A day with headache (b) Use of a triptan, ergotamine or other acute migraine-specific medication (e.g. ditans/gepants) (c) Headache successfully responded to the acute migraine-specific treatment defined as reduction from moderate or severe headache (severity of 2-3 out of 3 point scale) to mild or no-pain (severity to 0-1 out of 3 point scale) ≤ 2 hours post-dose The frequency of headache and migraine days determined whether a patient was classified as either a patient with chronic migraine (CM) or episodic migraine (EM) according to the ICHD-3. To this end, we used the typical migraine characteristics with a duration of ≥4 hours, in combination with triptan intake (effective or not) as the baseline definition. Also when a patients experienced (visual) aura symptoms with a duration between 5 and 60 minutes the day was considered a migraine day (see Table 1). We defined a headache day as a day with headache of at least 1 hour. By
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