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Is Migraine Considered Chronic Pain

What Causes Chronic Migraine

The Neurobiology of Chronic Migraine

Its not fully understood what causes chronic migraine.

For a lot of people chronic migraine develops gradually with migraine attacks becoming more frequent over time. Around 2.5 out of 100 people with episodic migraine will develop chronic migraine each year. For some people chronic migraine will go into remission within 2 years of becoming chronic.

The pattern of chronic migraine will vary depending on your individual circumstances. For some people it may return to episodic migraine, some people find it stays the same and others find that it gets worse.

There are a number of medical conditions that can increase your tendency to have migraine. These include:

Managing these can help with managing migraine and the effectiveness of migraine treatment.

The Stigma Of Chronic Migraine

At least once a week throughout my childhood, a migraine would force my mother to retreat into her bedroom. Shed shut the blinds and burrow under the covers, overwhelmed by a pain so severe it turned the faintest sound into an agonizing roar and launched waves of nausea with the slightest movement.

Though my family and I tried to be sympathetic, it was hard for us to fully comprehend my mothers migraines or understand why she had to miss so many events because of them. When youre on the outside looking in, you cant begin to appreciate how severely disablingand life disruptingchronic migraine can be.

Migraines And The Americans With Disabilities Act

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet. A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act .

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Learn More About Each Stage Of A Migraine:

1. Prodrome

One or two days before a migraine, you might notice subtle changes that warn of an upcoming migraine, including constipation, mood changes from depression to euphoria, food cravings, neck stiffness, increased thirst and urination or frequent yawning.

2. Aura

For some people, aura might occur before or during migraines. Auras are reversible symptoms of the nervous system. They’re usually visual, but they also can include other disturbances. Each symptom usually begins gradually, builds up over several minutes and lasts 20 minutes to one hour.

Examples of auras include:
  • Visual phenomena, such as seeing various shapes, bright spots or flashes of light
  • Vision loss
  • “Pins-and-needles” sensations in an arm or leg
  • Weakness or numbness in the face, or one side of the body
  • Difficulty speaking
  • Uncontrollable jerking or other movements

3. Attack

A migraine usually lasts from four to 72 hours if untreated, and the frequency varies by the person. Migraines might occur rarely or strike several times a month.

During a migraine, you might have:
  • Pain, usually on one side of your head, but often on both sides
  • Pain that throbs or pulses
  • Sensitivity to light, sound, and sometimes smell and touch
  • Nausea and vomiting

4. Post-drome

After a migraine attack, you might feel drained, confused and washed out for up to a day. Some people report feeling elated. Sudden head movement might bring on pain again briefly.

Learn more about headaches:

Whats The Outlook For People With Chronic Migraine

A Comprehensive Guide to Chronic Headache Conditions

The hope for people with chronic migraine is to control the headache. With a good treatment plan, it is reasonable to believe that the number and severity of migraine headaches can be reduced. Many patients with chronic migraine may revert to episodes of migraine over time.

For patients with chronic migraines that have not responded to previous treatments, there are other options. Some patients need more aggressive hands-on techniques such as nerve blocks and trigger point injections. Other patients particularly those with medication overuse headaches – need to rid their body of previous medications in a monitored setting, such as an infusion suite. In the infusion suite, patients receive intravenous medications that stop migraines and treat the nausea and vomiting.

For patients with the most difficult migraines to treat those not responding to any treatments, in whom detoxification efforts have not been totally effective, and patients are still using medications not helpful to improving their headache a team approach is required. The team, consisting of healthcare professionals from neurology, psychiatry, psychology, nursing, physical therapy and social work, meet together with the patient and the patients family over a series of weeks to develop a plan of care and monitor progress. Patients with difficult to treat migraines should ask their doctors to refer them to facilities that offer such multi-team, patient-centered programs.

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Chronic Pain And Cannabis Oil

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Can I Prevent Chronic Migraines

Taking care of yourself every day may prevent your migraines from turning into a long-term problem. For instance:

Catch some ZZZs. Not getting enough sleep can trigger a migraine. Aim for 7 to 8 hours of rest each night.

Watch your diet. While caffeine can soothe your pain, stopping it suddenly is a common cause of migraine. Other common food triggers include MSG , nitrates in cured meats like hot dogs, artificial sweeteners, and alcohol.

Manage your stress. Tension and worry are common triggers. Try to carve out a few minutes each day to do something you love, or learn to breathe deeply when youâre in the midst of a crisis. You might join a support group or talk to a counselor.

Have a meal plan. Fasting and skipping meals can trigger headaches. Try to eat around the same times each day.

Get moving. Exercise is a good way to ease your anxiety and stress. It can also help you get to, and stay at, a healthy weight. Since obesity raises your risk of chronic migraines, getting in shape is crucial.

Know your triggers. Not all migraines result from triggers. But if yours do, that set of triggers is unique to you. To learn what yours are, keep a headache diary. Each time you have an attack, write down details about what you were doing, how long the headache lasted, and how you felt before it started. This will help you begin to notice patterns — and avoid your triggers.

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Chronic Migraine Without Medication Overuse

The majority of individuals who experience chronic migraine use medicines to treat acute headache episodes. Treatment of acute episodes of chronic migraine involves the use of similar agents used in episodic migraine treatment. They include:

  • Simple analgesics
  • Non-steroidal anti-inflammatory drugs
  • Opioids
  • Triptans, a class of drugs which act as serotonin agonists which are usually only used if simple analgesics and NSAIDs fail to achieve pain relief
  • Ergotamines, a class of drug used in the treatment of migraine for over 5 decades, which has largely been replaces by triptans.

There is considerable debate regarding when medication for acute attacks should be taken. Early treatment reduces the severity of attacks and is thought to also reduce the frequency of attacks, thus facilitating reduced medication use. However, some argue that taking medication early in the course of a headache, before severe symptoms arise may encourage overuse of medicine. Discuss the best time to take preventative medications with your doctor and always use medicines according to your doctors advice.

When To Get Medical Advice

Doctor and chronic migraine patient discuss one solution to pain management

You should see a GP if you have frequent or severe migraine symptoms.

Simple painkillers, such as paracetamol or ibuprofen, can be effective for migraine.

Try not to use the maximum dosage of painkillers on a regular or frequent basis as this could make it harder to treat headaches over time.

You should also make an appointment to see a GP if you have frequent migraines , even if they can be controlled with medicines, as you may benefit from preventative treatment.

You should call 999 for an ambulance immediately if you or someone you’re with experiences:

  • paralysis or weakness in 1 or both arms or 1 side of the face
  • slurred or garbled speech
  • a sudden agonising headache resulting in a severe pain unlike anything experienced before
  • headache along with a high temperature , stiff neck, mental confusion, seizures, double vision and a rash

These symptoms may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible.

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Vasoactive Substances And Neurotransmitters

Perivascular nerve activity also results in release of substances such as substance P, neurokinin A, calcitonin gene-related peptide, and nitric oxide, which interact with the blood vessel wall to produce dilation, protein extravasation, and sterile inflammation. This stimulates the trigeminocervical complex, as shown by induction of c-fos antigen by PET scan. Information then is relayed to the thalamus and cortex for registering of pain. Involvement of other centers may explain the associated autonomic symptoms and affective aspects of this pain.

Neurogenically induced plasma extravasation may play a role in the expression of pain in migraine, but it may not be sufficient by itself to cause pain. The presence of other stimulators may be required.

Although some drugs that are effective for migraine inhibit neurogenic plasma extravasation, substance P antagonists and the endothelin antagonist bosentan inhibit neurogenic plasma extravasation but are ineffective as antimigraine drugs. Also, the pain process requires not only the activation of nociceptors of pain-producing intracranial structures but also reduction in the normal functioning of endogenous pain-control pathways that gate the pain.

An Adolescent Rating Scale

I continue to use the adult scale today and now proposes an adolescent chronic migraine refractory scale. Points for the adolescent patient would be tallied as follows:

  • Refractory to preventives = 1 point
  • Refractory to abortives = 1 point
  • Headache occurrence greater than one year = 1 point
  • Number of headaches per month if 25 or more days, on average = 1 point
  • Significant comorbidities if at least one are present = 1 point
  • Psychiatric comorbidities: severe Axis I, or a strong indication that Axis II may be present = 1 point.
  • Disability defined as an inability to go to school for at least 2 months due to headache , or a significant decrease in functioning = 1 point
  • Severe family dysfunction, which may include a personality disorder pathology in the primary parent = 1 point

With this scale, a total of 8 points would be possible, ranking as such:

  • 2 to 4 points = mild RCM
  • 5 to 6 points = moderate RCM
  • 7 to 8 points = severe RCM.

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Dealing With Chronic Headache Pain

Did you know that headaches are one of the leading types of chronic pain, along with back pain and arthritis? A headache may sound like a fairly minor ailment, but if you’re in pain every day, you know that chronic headaches can be very debilitating.

Getting a migraine or a cluster headache under control is a bit more complicated than taking two aspirin and calling your healthcare provider in the morning. Here’s what you should know about the various types of chronic headaches and your treatment options.

How Is Chronic Migraine Diagnosed

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Your doctor will take a detailed medical history. The doctor will ask about:

  • Your pattern of migraine pain, including when and how migraines begin if they are episodic or continuous how long the migraine lasts if there are any triggers or factors that make the migraine worse.
  • Your description of the pain, including its location, sensation, and severity.
  • Other symptoms that accompany the pain, such as auras, lack of energy, stiff neck, dizziness, changes in vision or in senses, and nausea/vomiting.
  • Your current and previously tried treatments, including when the medications are taken, dosages, outcome and side effects and use of alternative or complementary therapies.
  • Your medical history including other health problems , family history of headache, current non-headache medications, and lifestyle choices .

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Genetic And Epigenetic Component Of Migraine

Genetic factors may determine susceptibility to migraine, while different environmental factors can contribute to the development of a migraine attack . Mainly through genome-wide association studies , which tested for differences in allele frequencies of single nucleotide polymorphisms over the genome in migraine patients and controls , it is now understood that multigenetic variants, rather than individual genes, influence the susceptibility to migraine. Although GWAS in migraine, similarly to other disorders studied with GWAS , failed to shed light on the molecular changes that are responsible for the evolutive nature of migraine, one can envisage that combined knowledge from many variants will highlight which molecular pathways potentially could be involved in migraine pathophysiology .

Regardless of these outcomes, due to their small effect size no single SNP has any clinical use in predicting the risk of developing migraine. There is still a big challenge in the field of GWAS to link associated SNPs to actual genes and pathways. GWAS in migraine are yet to offer further knowledge on the functional consequences of the associated SNPs and how they influence susceptibility to migraine.

Is there a role for epigenetic mechanisms in migraine susceptibility and chronification?

The Trigeminal System And Its Role In Sustaining The Head Pain In Migraine

Despite the various evidence of increased blood flow changes in different brain nuclei before or during the onset of the headache phase, what really alters the excitability of the ascending trigemino-thalamic pathway in a manner that a migraine headache may develop in susceptible individuals remains to be revealed. Several lines of evidence suggest that the peripheral trigeminal system is of pivotal importance in driving the headache

  • a.

    The referred pain patterns of migraine headache are similar to the locations of referred pain after stimulation of meningeal and cerebral arteries, as observed in awake patients during brain surgery . The importance of these pain-sensing structures is their vast innervation by trigeminal fibres.

  • b.

    CGRP levels are increased during migraine attacks. Blood samples from patients or animal models during stimulation of the trigeminal fibres suggest that the origin of the CGRP found in migraine patients is indeed from the trigeminal nerve . CGRP is a potent vasodilator in the periphery and a modulator of nociceptive activity centrally. On second order neurons, CGRP has no effect on spontaneous neuronal firing but it can facilitate glutamatergic activity and nociceptive activation .

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    Preclinical Studies Of Chronic Migraine

    Although advancements in understanding chronic migraine pathophysiology and the development of novel therapeutics can potentially be achieved through preclinical studies, current animal models of chronic migraine remain limited. There are currently several techniques designed to induce headache-like pain in rodents, however, due to the complex nature of migraine, replication of the entire chronic migraine condition remains elusive. Since headache frequency is the key phenotypic difference of chronic migraine, repeated dural applications of inflammatory soup, intravenous infusions of glyceryl trinitrate and repetitive administration of acute migraine abortive treatments such as triptans to stimulate medication overuse headache have been most widely implemented to model chronic migraine .

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    Migraine And Vascular Disorders

    Migraine and ischemic strokes reportedly occur in 1.4-3.3 per 100,000 population and account for 0.8% of total strokes. Milhaud et al showed that in young patients with active migraine who had suffered ischemic stroke, risk factors such as patent foramen ovale, female gender, and oral contraceptive use were much more likely to be present posterior circulation stroke was characteristic. Surprisingly, older patients characteristically lacked vascular risk factors .

    Even in patients older than 45 years, women with migraine are more likely to suffer from ischemic stroke.

    Migraineurs, male and female, have a 2.5-fold increased risk of subclinical cerebellar stroke and those with migraines with aura and increased headache frequency are at the highest risk.

    Migraineurs also have a higher incidence of adverse cardiovascular profiles , and they are more likely to be smokers, have a family history of early heart attacks, and have an unfavorable cholesterol profile. The odds of an elevated Framingham risk score of coronary artery disease are doubled with migraine with aura, and women who have migraine with aura are more likely to be using oral contraceptives.

    These findings have been confirmed in a population-based study by Bigal et al. Similarly, a study by Gudmundsson et al found that men and women who have migraine with aura are at a higher risk for cardiovascular and all-cause mortality than are those without headache.

    Migraine Without Head Pain

    Also called a Silent or Acephalgic Migraine, this type of migraine can be very alarming as you experience dizzying aura and other visual disturbances, nausea, and other phases of migraine, but no head pain. It can be triggered by any of a persons regular triggers, and those who get them are likely to experience other types of migraine, too. The International Headache Society classifies this type as typical aura without headache.

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