Migraine "chronification": what you can do.

Each year approximately 3% of people with episodic migraine experience “chronification” of their headache disorder. “Chronic” migraine implies that the migraineur who previously was suffering relatively infrequent headache attacks now is plagued with headache at least 15 days out of the month, with at least 8 (but not necessarily all) of their headaches being migrainous in character. Chronic migraine is far from rare; as many as 6 to 8 million Americans may be afflicted by this malignant variant of migraine that is particularly inclined to diminish one’s quality of life and is relatively difficult to subdue with the medical therapies currently available. While – at last – research involving headache is shifting to address the needs of the chronic migraine population, it remains and, whatever new treatments emerge, is likely to remain a disorder best treated by preventing its development in the first place. Once chronic migraine has developed, its successful treatment – with remission back to the episodic form – will require active participation on the part of the patient. While our knowledge of the biologic factors that promote and sustain migraine “chronification” is far from complete, we have come to identify a number of factors that are associated with the disorder . . . and a few that clearly appear to herald its development. Not surprisingly, a steady increase in headache attack frequency is a potent risk factor for the development of chronic migraine. In parallel with this, overuse of medications intended to treat headache acutely may accelerate the “chronification” process and reinforce chronic migraine once it has developed. Even relatively low levels of use of certain classes of drugs may be linked to eventual “chronification”; opiates/opioids (“narcotics”) and barbituate-containing compounds have been reported to be the most potent offenders in this regard. A number of studies have reported obesity and chronic migraine to correlate strongly,and an association between chronic migraine and disorders of mood (notably, anxiety and depression) has been well established. Chronically disrupted sleep may predispose to – or, at least, reinforce – chronic migraine. Finally, a history of severe emotional or physical trauma may predispose to chronic migraine, and the traumatic event itself may be widely separated in time from the onset of migraine “chronification” process. So what can you, the migraineur, do to assist in preventing chronic migraine or, if you are already at that point, achieve remission back to episodic headache?