Migraine is a debilitating disorder that can be subdivided into several categories. Two of those categories, chronic migraine and episodic migraine, are both part of a tapestry of migraine disorders. One of the things many people are not aware of when first diagnosed with migraine is that this is a complex neurological disease that can chronify. This means that it is possible to go from low frequency episodic to high frequency episodic and then to chronic migraine.
Episodic vs Chronic Migraine
We know that migraine disease affects about 12-14% of the population, with 3-5% falling in the category of chronic migraine. So let’s first look at the difference between episodic and chronic:
- Episodic Migraine: Patients with migraine attacks that occur on less than 15 days per month are diagnosed with episodic migraine. Those with episodic migraine can go weeks, months, even years without experiencing any migraine symptoms, especially if they are considered “low frequency episodic.”
- Chronic Migraine: Chronic migraine occurs in patients who experience migraine attacks on 15 or more days per month for at least 3 months. Studies have shown that patients with chronic migraine are considerably more disabled than those with episodic migraine. Quality of life is often significantly impacted.
Chronification of Migraine
When you have migraine attacks your nervous system starts to become more sensitive to pain stimuli. This in turn makes future attacks more likely and harder to treat, your risk of disease chronification increases, and then you experience more migraine attacks. While it is possible to reverse this chronification, it can be very challenging to do so and the ideal situation is to do everything possible to prevent it happening ahead of time.
Clinically, the nature of episodic migraine is very much the same as chronic migraine. Symptoms include:
- Pain in the face, scalp or neck
- Throbbing headache, which is often one-sided
- Gastrointestinal disturbances
- Visual disturbances
- Sensitivity to light and sound
- Nasal congestion
- And more
However, people with chronic migraine are more likely to report multiple comorbidities than episodic migraine patients, including anxiety and depression, other pain disorders, and vascular and respiratory conditions. In addition, the level of disability often radically increases as chronification occurs, and quality of life is reduced, resulting in migraine disease having an impact on all aspects of life.
Approximately 2.5% of episodic migraine patients will chronify annually, and several risk factors for the progression from episodic to chronic migraine have been identified. However, sometimes these factors have been presented to patients in a way that creates inappropriate blame, and it is important to remember that most of them have a bi-directional relationship. This means that while migraine is more likely to chronify in these situations, once migraine has chronified these are also more likely to happen, creating a vicious circle. Factors include:
- Lack of appropriate, timely and effective preventive treatment
- Comorbid psychiatric disorders
- Presence of other pain disorders
- Stressful life events
- Abortive/acute medication overuse
My Migraine Story
I was diagnosed with migraine at the age of 8. This was back in the 70’s, and all I got from my primary doctor was a look of pity and a recommendation to take aspirin and lay in a dark room until the migraine attacks passed. For most of my childhood, my migraine was episodic and didn’t have a significant impact on my life. As I got older, hormones kicked in, life got more stressful, and my migraine attacks became more frequent. Lack of understanding in the medical community was a major barrier to my receiving treatment. Some doctors thought I was faking to get out of school. Some thought it was a psychiatric problem and I was sent to multiple therapists. Some thought it was a musculoskeletal problem and I went to more physical therapists and chiropractors than I can count. I was given muscle relaxants and benzodiazepines, both of which had little to no effect on my migraine frequency or severity.
In the 90’s, I was introduced to a triptan medication and it worked wonders, but I didn’t have health insurance at the time and couldn’t afford it. Since preventive treatment was never offered to me, I very quickly became chronic and I have been chronic ever since. Every aspect of my life has been affected. I’ve lost jobs, friendships, a marriage. Forty three years of migraine has taken a toll on me both mentally and physically.
Preventing Chronic Migraine
Could my chronification have been prevented? Preventing chronic migraine isn’t always possible, but there are many steps one can take to mitigate this progression as listed above. However, the most important step one can take to help prevent chronification is appropriate, timely and effective preventive treatment. We are very fortunate nowadays in that there are a huge number of preventive treatment options. There is also more awareness of the need to have a holistic “toolbox” approach including medications, supplements, lifestyle changes, medical devices, integrative treatments, and OTC options.
I feel very fortunate that I have access to a headache specialist who listens, cares and is treating me appropriately. I’m currently taking an anti-cgrp medication, managing stress, and visiting a massage therapist weekly who specializes in migraine massage – as a result, I have gotten my frequency down to 5-6 migraines per month. After suffering with chronic migraine for 32 years, this is a miracle for me! My advice to anyone suffering with migraine is to empower yourself. Ask for help. Seek out a headache specialist and ask about preventive options. With the right action plan, you may be able to prevent your episodic migraine from increasing in frequency and becoming chronic, and you may even be able to reverse chronification if it has already happened.
Let us know: Has your doctor talked to you about preventive treatment options? Do you have a good headache specialist? And, did you know that migraine disease can progress and chronify?
Source: National Library of Medicine, National Center for Biotechnology Information
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