Chronic Migraine: Overview, Causes, Symptoms, and Treatment

Overview

• Definition: Chronic migraine is characterized by frequent or long-lasting episodes of headaches and migraines. Symptoms can shift daily, making it hard to distinguish individual episodes.
• Distinction: Migraines are more severe than headaches and directly affect the brain, often disrupting daily activities.

Prevalence

• Worldwide Prevalence: Migraines affect 12%-15% of the global population; chronic migraines affect 1%-2.2%.
• Demographics: More common in females; often start at puberty and reduce post-menopause.

Symptoms and Diagnosis

Symptoms

• Chronic migraines involve headaches lasting longer or occurring more frequently than episodic migraines.
• Diagnosis requires:
  • 15 headache/migraine days per month for at least three months.
  • 8 days with migraine-specific symptoms.

Migraine Stages

1. Prodrome: Pre-migraine indicators.
2. Aura: Brain disruption symptoms.
3. Headache: Pain phase.
4. Postdrome: Aftereffects, often referred to as "migraine hangover."

Symptoms Criteria

• Without Aura: Lasts 4-72 hours, with distinct pain characteristics and possibly nausea, vomiting, photophobia, or phonophobia.
• With Aura: Includes visual, touch, speech, motor, brainstem, or retinal symptoms with specific progression criteria.

Causes

• Genetic Predisposition: Family history increases risk.
• Potential Processes:
  • Blood flow changes.
  • Brain cell electrical signal issues.
  • Neurotransmitter level shifts.
  • Nerve signaling malfunctions.
  • Chronic pain effects.

Risk Factors and Triggers

• Risk Factors: Obesity, head injuries, chronic pain conditions, mental health issues, sleep disorders.
• Triggers: Stress, hormonal changes, hunger, dehydration, sleep disturbances, specific foods or environmental factors.

Complications

• Possible but rare, including status migrainosus, strokes, seizures, and heart attacks.

Diagnosis

• Combination of medical history, neurological exam, and diagnostic imaging.
• Questions focus on headache characteristics, frequency, associated symptoms, and lifestyle factors.

Treatment and Management

Medications

• Preventive: Reduce severity/frequency (e.g., ARBs, antiseizure meds, antidepressants, beta-blockers, Botox, monoclonal antibodies).
• Rescue: Shorten migraine duration (e.g., NSAIDs, triptans).

Procedures

• Nerve stimulation, TMS, alternative methods like acupuncture.
• Mental health therapies to manage stress and anxiety.

Prevention

• Reducing risk involves medication management to prevent transformation from episodic to chronic.

Prognosis and Living with Chronic Migraine

• Outlook: Chronic migraine can shift between episodic and chronic forms; tends to decrease with age.
• Self-care: Keep a migraine journal, manage lifestyle and diet, use technology for tracking, learn triggers, join support groups.
• Emergency Care: Recognize severe symptoms requiring ER visits, such as thunderclap headaches or hemiplegia.

Additional Information

• Seriousness: Chronic migraine is not life-threatening but very disruptive.
• Possibility of Resolution: Can decrease with age or transform back to episodic forms.

Note: Chronic migraine requires ongoing management and can be significantly disabling, impacting daily activities and quality of life.