Page 13 - The clinical aspects and management of chronic migraine Judith Anne Pijpers

Migraine and migraine chronification
Migraine is a complex, multifactorial brain disorder, characterized by recurrent attacks of moderate to severe headache, typically accompanied by nausea, vomiting and hypersensitivity to movement, light and sound.1–3 In one-third of patients, these headache attacks are preceded by transient focal neurological symptoms, called migraine aura. Migraine aura usually comprises visual symptoms, such as scintillating scotomas, but may occur as paresthesia, motor weakness or dysphasia. These symptoms are gradually developing over several minutes, lasting for 5-60 minutes.4,5 Furthermore, most patients experience premonitory symptoms in the preceding days, such as mood and cognitive changes, food craving or neck stiffness.6,7
Migraine is a common disorder with a lifetime prevalence of 13.3%-33%, and most prevalent at the age of 35-50 years;8 a socially and economically demanding period. As such, migraine is the second leading cause of Years Lived with Disability worldwide.9 Most migraine patients have episodic migraine (< 15 headache days per month), with a median attack frequency of one per month.8 However, every year 3% of these patients transform into chronic migraine, a high frequent variant of migraine with ≥ 15 headache days per month, of which at least 8 migraine days (box 1).3,10 This transformation process is called migraine chronification. As a consequence of the high attack frequency, chronic migraine patients experience even more impairment on socioeconomic functioning and quality of life,11 and the direct and indirect costs of chronic migraine are estimated to be fourfold higher compared to episodic migraine.10
Box 1. Chronic migraine criteria. Aggregation of the criteria on migraine and chronic migraine according to the International Classification of Headache Disorders (ICHD-3β criteria)3.
1
General introduction
Chronic migraine
A. Headache (tension-type-like and/or migraine-like) on ≥15 days per
month for ≥3 months
B. Headache occurring in a patient who has had at least five attacks
fulfilling criteria of migraine with or without aura
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