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By Dr. Bernard Abrams
There is new recognition that migraine headaches are not just an episodic disorder but a progressive disorder in many cases. “There is a great necessity to prevent disease progression and recognition so that, in the future, successful management of migraine will ideally be measured not by attack termination, but by prevention or reversal of disease progression. Thus, the role of preventative therapy will likely become more central to migraine management.” Thus, prevention becomes the duty of all healthcare providers who render service to migraine patients. Or, as Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.”
Chronic migraine is one of the varieties of chronic daily headaches that afflict approximately 3 to 5% of the population worldwide. The quality of life for chronic daily headache sufferers was studied using Short Form-36. In this study, 89 patients were compared to 89 healthy controls; in the patients, there was a significant decrease in each health-related concept as compared with the healthy subjects. The highest decreases were seen for role physical, bodily pain, vitality, and social functioning.
Chronic daily headache is divided into primary and secondary types. Secondary headaches are those with a demonstrable cause, such as brain tumor or trauma, and caution dictates that secondary causes of headaches must be ruled out first.
The primary types of chronic daily headaches, besides chronic migraine are:
*Overuse or medication rebound headache often complicates chronic migraine and other forms of chronic daily headache.
Chronic migraine headaches, previously called transformed migraine, were defined in 2004 by the International Headache Society (IHS) as occurring 15 or more days per month for a period of at least three months. In 2006, the IHS published an appendix defining chronic migraine as being characterized by a pattern of headaches experienced by the patient, rather than focusing on symptoms of individual headache attacks.
This elaboration of the concept of chronic migraine produced several significant effects. First, it identified the potentially progressive nature of migraine with the concept that episodic migraine was not only an episodic disorder, but a precursor to chronic migraine. Additionally, attention to the early and effective treatment of the episodic disorder might prevent progression to the chronic disorder. Secondly, it called attention to the fact that “migraine is a potentially chronic, progressive disease that substantially affects patients, families, work places, and society.” Third, this elaboration points out that there was a spec- trum of clinical phenotypes, ranging from IHS migraine to IHS tension-type headaches, which are responsive to triptans. Finally, it suggests that there might be a common mechanism for chronic migraine in all its phenotypes.
Two recent articles highlight new opportunities for patients and healthcare professionals to improve communication and understanding of the disease of migraine.