Mechanism of Chronic Migraine

Chronic migraine typically evolves from episodic migraine over months to years in susceptible individuals. Headaches increase in frequency over time, becoming less intense but more disabling and less responsive to treatment. Results of electrophysiologic and functional imaging studies indicate that...

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Bibliographic Details
Published in:Current pain and headache reports 2011-02, Vol.15 (1), p.57-63
Main Authors: Aurora, Sheena K., Kulthia, Arun, Barrodale, Patricia M.
Format: Article
Language:English
Subjects:
Brain Stem - physiopathology
Chronic Disease
Disease Progression
Humans
Internal Medicine
Medicine
Medicine & Public Health
Migraine
Migraine Disorders - epidemiology
Migraine Disorders - physiopathology
Pain Medicine
Pain Threshold - physiology
Risk Factors
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Summary:Chronic migraine typically evolves from episodic migraine over months to years in susceptible individuals. Headaches increase in frequency over time, becoming less intense but more disabling and less responsive to treatment. Results of electrophysiologic and functional imaging studies indicate that chronic migraine is associated with abnormalities in the brainstem that may be progressive. Additionally, chronic migraine is associated with a greater degree of impairment in cortical processing of sensory stimuli than is episodic migraine, perhaps due to a more pervasive or persistent cortical hyperexcitability. These findings fit with the model of migraine as a spectrum disorder, in which the clinical and pathophysiological features of migraine may progress over time. This progression is postulated to result from changes in nociceptive thresholds and ensuing central sensitization caused by recurrent migraine in susceptible individuals, for whom a variety of risk factors have been described. This may lead to changes in baseline neurologic function between episodes of headache, evident not only in electrophysiologic and functional imaging studies, but also as an increase in depression, anxiety, nonhead pain, fatigue, gastrointestinal disorders, and other somatic complaints that may occur after years of episodic migraine. From the current research and migraine models, a conceptualization of chronic migraine, in which relatively permanent and pervasive central changes that warrant novel and tolerable treatments have occurred, is emerging. This model also implies that prevention of chronic migraine is an important goal in the management of episodic migraine, particularly in individuals who exhibit risk factors for chronic transformation.
ISSN:1531-3433
1534-3081
DOI:10.1007/s11916-010-0165-z