IMPACT OF CHRONIC MIGRAINE
Did you know that more than 4 million adults in the US have chronic migraine?1
Learn more about the impact of chronification and the burden of
chronic migraine.
Chronic migraine is more than a headache
Chronic migraine patients have high disease burden.4
Gaps in chronic migraine
identification and diagnosis
ICHD-3 diagnostic criteria distinguish chronic migraine as a headache that occurs on at least 15 days per month for more than 3 months, of which at least 8 days have migraine features.6
*Figure not representative of all barriers studied in the Chronic Migraine Epidemiology and Outcomes study. ICHD-3=International Classification of Headache Disorders, Version 3.High disease burden in chronic migraine patients
In comparison with people with episodic migraine, those with chronic migraine
experience substantially greater impact on
daily activities, higher direct medical costs, greater healthcare resource
utilization, reduced health-related quality of life,
and higher rates of comorbidities.4,7
*P<0.001 compared to chronic migraine.
HA=headache.
Chronic migraine comorbidities
People with chronic migraine experience higher rates of comorbidities. Chronic migraine comorbidities may include:4,6-14
Refractory to acute treatments for migraine
Medication overuse
Gastrointestinal issues
Cardiac risk factors
Fatigue
Sleep disorders
Neck pain
High BMI
Allodynia
Why is it important to diagnose chronic migraine?
Chronic migraine patients have different needs and distinct disease pathophysiology.2,3
While more than 4 million individuals in the US have chronic migraine, less than 5% of them consult a healthcare provider, are accurately diagnosed, and receive a minimally appropriate treatment.
Yet internationally, ICHD-3 recognized chronic migraine as a primary headache disorder. In doing so, the ICHD-3 diagnostic criteria distinguish chronic migraine as a headache that occurs on at least 15 days per month for more than 3 months, of which at least 8 days have migraine features.
But how chronic migraine manifests extends beyond just a headache. Patients with chronic migraine may also have:
A. Unique structural and functional changes in the brain
B. Persistent central sensitization and high rates of allodynia.
C. And increased patient disease burden.
Functional magnetic resonance imaging studies identified structural and functional differences in the brains of chronic migraine patients compared to Episodic Migraine patients and healthy controls. In some patients, frequent migraine attacks may be associated with changes that influence pain perception.
Some studies show iron accumulation in the periaqueductal grey matter, others show the pons and rostral medulla can remain overactive between migraine attacks.
Persistent state of central sensitization is common during chronification.
And clinically, a hallmark of chronic migraine is allodynia, manifesting as pain, even with actions that are usually not painful, such as hair brushing.
Compared to episodic migraine, patients with chronic migraine have a markedly increased disease burden and decreased quality of life as measured by the Migraine Disability Assessment, and Headache Impact Test.
Chronic migraine patients have high disease burden and unique pathophysiology. Address chronic migraine through timely diagnosis and by tailoring your treatment approach.
References
1. Understanding chronic migraine. American Migraine Foundation.
https://americanmigrainefoundation.org/resource-library/understanding-chronic-migraine/
2. Schwedt TJ. Headache. 2015;55(6):762-777.
3. Pozo-Rosich P et al. Cephalalgia. 2021;41(5):613-630.
4. Adams AM et al. Cephalalgia. 2015;35(7):563-578.
5. Buse DC et al. Headache. 2021;61(4):628-641.
6. Headache Classification Committee of the International Headache Society.
Cephalalgia. 2018;38:1-211.
7. Lipton RB et al. Headache. 2016:56(8):1280-1289.
8. Blumenfeld AM. Cephalalgia. 2011;31(3):301-315.
9. Messali A et al. Headache. 2016;56(2):306-322.
10. Ford JH et al. Headache. 2017;57(10):1532-1544.
11. Bigal ME et al. Headache. 2003;43(4):336-342.
12. Buse DC et al. Headache. 2012;52(1):3-17.
13. Bigal ME et al. Neurology. 2008;71(8):559-566.
14. Lipton RB et al. Headache. 2020;60(10):1683-1696.
