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What Is Chronic Migraine Syndrome

Barriers To Effective Care

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Lack of knowledge among health-care providers is the principal clinical barrier. Worldwide, on average, only 4 hours of undergraduate medical education are dedicated to instruction on headache disorders. A large number of people with headache disorders are not diagnosed and treated: worldwide only 40% of those with migraine or TTH are professionally diagnosed, and only 10% of those with MOH.

Poor awareness extends to the general public. Headache disorders are not perceived by the public as serious since they are mostly episodic, do not cause death, and are not contagious. The low consultation rates in developed countries may indicate that many affected people are unaware that effective treatments exist. Half of people with headache disorders are estimated to be self-treating.

Many governments, seeking to constrain health-care costs, do not acknowledge the substantial burden of headache on society. They might not recognize that the direct costs of treating headache are small in comparison with the huge indirect-cost savings that might be made if resources were allocated to treat headache disorders appropriately.

Prophylactic Treatment Of Chronic Migraine

Prophylactic treatment, that is the use of preventative medications for chronic migraine aims to reduce the frequency of acute attacks, lessen the impairment the individuals experience during an attack and reduce the use of acute medication. Most of the medications used in migraine have not been evaluated for efficacy in treating chronic migraine, however they are commonly used and considered effective in clinical practice. However, there is now a clinically proven injectable treatment that is licenced under the PBS that is effective for prevention. The reduction in headache days, intensity and improvement of quality of life measures have been statistically shown to be significant. Advantages of this therapy include no sedative properties or interaction with other medications. In Australia, patients are required to satisfy criteria for chronic migraine and have tried or be unsuitable for 3 prophylactic oral agents.

S That Can Help Reduce The Risk Of Headache Progression

  • Avoid using over-the-counter and acute prescription headache medications more than two days a week, with rare exceptions. If this is difficult, a daily medication to prevent migraine attacks may be useful.
  • Minimize, better yet, eliminate use of caffeine.
  • Make lifestyle changes that help to manage stress including:
  • Routine exercise

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What Is Migraine Symptoms Causes Diagnosis Treatment And Prevention

Migraine is a neurological disease characterized by repeated episodes of symptoms, called attacks, that usually include headache, often accompanied by nausea vomiting sensitivity to light, touch, smell, or sound dizziness visual disturbances and tingling or numbness in the face, hands, or feet.

Migraine attacks may come on suddenly without warning, or they may be preceded by certain known triggers, such as skipping a meal, being exposed to smoke or air pollution, or experiencing a change in hormone levels as part of the menstrual cycle. Most migraine attacks last from 4 to 72 hours, although effective treatment can shorten them to a matter of hours. On the other hand, some migraine attacks can last even longer than 72 hours.

Having migraine can be disabling and can lead to missing days of school or work, being less productive at school or work, being unable to perform household responsibilities, and missing out on family, social, and leisure activities.

An estimated 1 billion people worldwide, and 39 million Americans, have migraine.

While a variety of triggers can set off migraine attacks, they dont directly cause the attacks or the underlying disease.

Transformed Migraine/medication Overuse Headache

Headaches and Migraines in Fibromyalgia, ME/CFS

In some patients, migraine progresses to chronic migraine. Acute overuse of symptomatic medication is considered one of the most important risk factors for migraine progression. Medication overuse headache can occur with any analgesic, including acetaminophen or nonsteroidal anti-inflammatory drugs , such as ibuprofen, naproxen, and aspirin. In addition, Bigal and Lipton identified the following associations of medication with progression to chronic migraine :

  • Opiates – Critical dose of exposure is around 8 days per month the effect is more pronounced in men

  • Barbiturates – Critical dose of exposure is around 5 days per month the effect is more pronounced in women

  • Triptans – Migraine progression is seen only in patients with high frequency of migraine at baseline

In the study, the effect of anti-inflammatory medications varied with headache frequency. These agents were protective in patients with fewer than 10 days of headache at baseline but induced migraine progression in patients with a high frequency of headaches at baseline.

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The Hope For People With Chronic Migraine Is To Control The Headache With Timely Diagnosis And A Suitable Treatment Plan It Is Reasonable To Believe That The Number And Severity Of Migraine Headaches Can Be Reduced

Chronic Migraine: Its more than a bad headache, Expert Says

Migraines are often disregarded as just another headache. Pain or ache in the head is just one of the many symptoms of migraines which are a neurological disease that involve nerve pathways and chemicals. If someone has a headache for 15 days a month, out of which eight days the headache occurs with migraine features, and this happens for three months or more, they are probably suffering from chronic migraine. What begins as headaches of a lesser frequency develop a more frequent pattern, thus becoming chronic. Chronic migraine is, much more than a headache. To identify and distinguish a chronic migraine from common headaches, one must know and identify the symptoms which include moderate to severe intensity headache, throbbing pain, pain on both sides of the head, dizziness, vomiting, nausea, and sensitivity to light, sound, and smells. Chronic migraine and migraine shares same symptoms. The difference is in the timing. To be diagnosed with this condition, you’ll have headaches at least 15 days a month.

Every person who has chronic migraine, has different triggers, but common ones include a lack of sleep, caffeine, and being under stress. Most people who get chronic migraines are women. This is because of the hormonal changes at different stages of life. During menstrual phase, pregnancy or menopause, women undergo a lot of hormonal changes and hence can experience or act as a trigger to chronic migraine attack.

Who Gets Chronic Migraine

Roughly 2 out of every 100 people worldwide have chronic migraine. Doctors do not know what causes chronic migraine, but they think it may be caused by changes in the brainstem after years of less frequent or episodic migraine. Poorly treated headaches and migraine attacks seems to increase the risk of developing chronic migraine.1

Other risk factors for chronic migraine include:1

  • Frequent use of drugs to abort migraine head pain
  • Obesity
  • Untreated depression and anxiety

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Who Is At Risk For Migraines

About 12% of Americans get migraines. They can affect anyone, but you are more likely to have them if you:

  • Are a woman. Women are three times more likely than men to get migraines.
  • Have a family history of migraines. Most people with migraines have family members who have migraines.
  • Have other medical conditions, such as depression, anxiety, bipolar disorder, sleep disorders, and epilepsy.

The Evolutive Migraine Attack

What is Migraine Disease?

Migraine is cyclic disorders with a complex sequence of symptoms within every headache attack. In its episodic form, migraine is characterised by recurrent attacks involving different phases: . A premonitory phase prior to the onset of the actual headache, characterised by symptoms, such as excessive yawning, thirst, somnolence, food craving, cognitive difficulties, and mood changes . Transient neurological symptoms, known as migraine aura , that occur just before the actual headache starts . . An intense headache attack, usually involving only one site of the head, which can be exacerbated by movement and accompanied with hypersensitivity to sensory stimuli , nausea . The postdrome phase which is mainly characterised by symptoms of fatigue, difficulties in concentration and comprehension, and neck stiffness . During the interictal phase, although patients may appear normal, genetic predisposition and a number of triggers make them susceptible to an attack.

Fig. 1

Migraine is cyclic disorders with a complex sequence of symptoms within every headache attack. In its episodic form, migraine is characterised by recurrent attacks involving different phases, with a complex sequence of symptoms within every phase. Significant advances have been made in characterising migraine as a brain disorder and in identifying evolutive functional changes in different brain areas during the different phases of a migraine attack

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Can Chronic Migraine Be Prevented

Keep a daily headache diary. As soon as you notice an increase in the number of headaches you are having, see your headache specialist. Do not wait until your headaches become a daily occurrence to seek help. It is easier to halt and reverse chronic migraine if caught early.

Look at the risk factors and modify those you can .

Treatment Of Chronic Migraine

There are three broad approaches to treating chronic migraine: lifestyle and trigger management, acute treatments , and preventive treatments . While many patients find that lifestyle adjustments such as regularizing meals and sleep can reduce the frequency of their attacks, some form of medication or other treatment is almost invariably necessary in patients with chronic migraine. The National Institute for Health and Care Excellence have recently published guidance on the diagnosis and treatment of migraine, and further consensus guidelines have been published by the British Association for the Study of Headache, the American Headache Society and American Academy of Neurology, and the European Headache Federation .

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What Is A Chronic Daily Headache

Chronic daily headache is a type of frequently occurring headache which may be further classified aseither:

  • Chronic migraine, previously known as transformed migraine, is a condition where episodic migraine-type headaches occur more frequently until the individual experiences a migraine on > 15 days per month or
  • Medication overuse headache, which refers to a headache syndrome in which an individual who previously experienced episodic primary headaches does so with increasing frequency, and is unable to achieve appropriate pain relief with normal medication doses. Medication use thus increases and, paradoxically, contributes to headache pain.

Chronic daily headache is thought to most typically occur as a result of medication overuse. The increasing severity and frequency of headache symptoms is usually a withdrawal effect of addictive pain killers used to treat migraine or other types of primary headache . Frequent and regular use of medications used to treat headaches can induce headaches and increase the individuals requirement to use medication. However, some argue the order of events is reversed and that increasing frequency of headaches results in overuse of medication, rather than vice versa.

Migraine Characteristics And Treatment

Pin on Migrene

Migraine is characterized most often by unilateral head pain that is moderate to severe, throbbing, and aggravated by activity. It may also be associated with various visual or sensory symptoms, which occur most often before the headache component but which may occur during or after the headache these are collectively known as an aura. Most commonly, the aura consists of visual manifestations, such as scotomas, photophobia, or visual scintillations .

The head pain may also be associated with weakness. This form of migraine is termed hemiplegic migraine.

In practice, however, migraine headaches may be unilateral or bilateral and may occur with or without an aura. In the current International Headache Society categorization, the headache previously described as classic migraine is now known as migraine with aura, and the headache that was described as common migraine is now termed migraine without aura. Migraines without aura are the most common, accounting for more than 80% of all migraines.

The diagnosis of migraine is clinical in nature, based on criteria established by the International Headache Society. A full neurologic examination should be performed during the first visit, to exclude other disorders the findings are usually normal in patients with migraine. Neuroimaging is not necessary in a typical case, but other diagnostic investigations may be indicated to guide management.

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Migraine As A Life Span Disorder

Migraine is a life span disorder affecting children, adults and the elderly. The clinical presentation of migraine shows an age-dependent change with shorter duration and also occurrence of special paroxysmal symptoms like vomiting, abdominal pain or vertigo in childhood and largely an absence of autonomic signs in the elderly.

The prevalence of migraine in children varies, depending on the study and the age range of the included subjects, between 2.7% and 10.0% and in younger children it does not differ between girls and boys . In adulthood, migraine is more prevalent in women than in men with a lifetime prevalence of 1217% and 46%, respectively . A factor that may contribute to the increased prevalence of migraine in women compared to men in the reproductive years is estrogen withdrawal which is a reliable trigger of menstrual attacks in women . Migraine in women usually declines after menopause , indicating further the influence of hormonal changes on migraine occurrence. The prevalence of migraine in the elderly is about 3.5% with females affected ~2 times more often than males .

The clinical manifestation of migraine is different in childhood from that in adulthood. Pediatric migraine is characterized by shorter attacks with the pain being less often unilateral. Accompanying symptoms include mild intolerance to light and rarely to noise , while vomiting and cranial autonomic features are significantly more frequent compared to adult patients .

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.

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Alternative And Complementary Therapies

In addition to medications, lifestyle changes can help you avoid certain triggers, potentially preventing some migraine attacks. Practicing relaxation exercises, such as yoga and meditation, may ease migraine pain.

While the evidence isnt definitive, some people with migraine have found that home remedies and alternative therapies such as acupuncture and biofeedback are effective. Consult with your healthcare provider to find an approach that works for you.

According to MedlinePlus, you should see your doctor if there are changes in your headache pattern, if treatments youve been using stop working, if your headaches are more severe when youre lying down, or if you have bothersome side effects from your medication.

You should call 911 if you have problems with speech, vision, movement, paralysis, or loss of balance, particularly if youve never had these symptoms before with a migraine. If your headache starts suddenly, it may be an emergency.

How Long Can Chronic Migraine Last

What Is a Migraine Headache?

There are certainly people who, unfortunately, develop a more or less continuous headache and experience headache every single day. Then there are those who will have very long attacks lasting for a week, for example and so two of those per month would qualify as having chronic migraine.

Much more common is the former situation where headache is happening either every other day or every single day, in those with chronic migraine.

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How Is Chronic Migraine Treated

Treatment of chronic migraine is focused on managing lifestyle choices and headache triggers, managing migraine attacks and providing preventive treatments to reduce migraine attacks.

Lifestyle changes include:

  • Beginning treatment for any existing mood disorder or sleep problem.

The typical treatment plan for managing migraine attacks includes:

  • Treating migraine attacks early when pain in mild begin with a simple pain killer and slowly increase the dose as needed to the max tolerated dose, unless the headache is severe at the start or will become severe. In such cases add a triptan to the above medication to improve efficacy. Avoid use of opiates if possible. Your doctor will devise a treatment plan to avoid worsening chronic headache by overusing medications.
  • Treat associated side effects, such as nausea.
  • Consider other treatment techniques, including transcranial magnetic stimulation and transcutaneous supraorbital nerve stimulation.

Preventive treatment is aimed at reducing the number of headaches. Preventive treatments include:

Chronic Migraine When Someone Has More Than 15 Headache Days Per Month Affects 35% Of The Us Population

Migraine is a common and disabling condition reported in approximately 12% of the population. In the Global Burden of Disease Study in 2019, migraine was found to be the third highest cause worldwide of years lived with disability. Migraine attacks sometimes increase in frequency over time. Headache experts divide this process of transition into three distinct states:

  • No migraine
  • Episodic migraine
  • Chronic migraine

Chronic migraine occurs in 35% of the U.S. population. Its possible for someone with episodic migraine to develop chronic migraine. In addition, studies suggest that about 3% of people with episodic migraine will transition to chronic migraine each year.

Read more to learn about the symptoms, risk factors, diagnosis and treatment of this condition.

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