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Mechanisms of Chronic Migraine

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Handbook of Headache

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Abstract

Chronic migraine typically evolves from episodic migraine over months to years in susceptible individuals. Headaches increase in frequency over time, becoming less intense but more disabling and less responsive to treatment. The results of electrophysiological and functional imaging studies indicate that chronic migraine is associated with abnormalities in the brain stem that may be progressive. Additionally, chronic migraine is associated with a greater degree of impairment in cortical processing of sensory stimuli than is episodic migraine, perhaps due to a more pervasive or persistent cortical hyperexcitability. These findings fit with the model of migraine as a spectrum disorder, in which the clinical and pathophysiological features of migraine may progress over time. This progression is postulated to result from changes in nociceptive thresholds and ensuing central sensitization caused by recurrent migraine in susceptible individuals, for whom a variety of risk factors have been described. This may lead to changes in baseline neurologic function between episodes of headache, evident not only in electrophysiological and functional imaging studies, but also as an increase in depression, anxiety, nonhead pain, fatigue, gastrointestinal disorders, and other somatic complaints that may occur after years of episodic migraine. From the current research and migraine models, a conceptualization of chronic migraine is emerging in which relatively permanent and pervasive central changes have occurred that warrant novel and tolerable treatments. This model also implies that prevention of chronic migraine is an important goal in the management of episodic migraine, particularly in individuals who exhibit risk factors for chronic transformation.

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Author information

Authors and Affiliations

  1. Swedish Headache and Pain Center, Swedish Neurosciences Institute, 1101 Madison, Suite 200, Seattle, WA, 98116, USA

    Sheena K. Aurora MD

  2. Houston Headache Clinic, 1213 Hermann Drive, Suite 820, Houston, TX, 77004, USA

    Ninan T. Mathew MD

Authors
  1. Sheena K. Aurora MD
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  2. Ninan T. Mathew MD
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Corresponding author

Correspondence to Sheena K. Aurora MD .

Editor information

Editors and Affiliations

  1. Department of Medical and Molecular Sciences, School of Health Sciences, Sapienza University of Rome, Rome, Italy

    Paolo Martelletti

  2. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway

    Timothy J. Steiner

  3. Department of Neuroscience, Faculty of Medicine, Imperial College London, London, UK

    Timothy J. Steiner

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© 2011 Lifting The Burden

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Aurora, S.K., Mathew, N.T. (2011). Mechanisms of Chronic Migraine. In: Martelletti, P., Steiner, T.J. (eds) Handbook of Headache. Springer, Milano. https://doi.org/10.1007/978-88-470-1700-9_31

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  • DOI: https://doi.org/10.1007/978-88-470-1700-9_31

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1699-6

  • Online ISBN: 978-88-470-1700-9

  • eBook Packages: MedicineReference Module Medicine

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