Listening to the Migraine World Summit talk called Progressive Migraine Risk factors with Richard Lipton. To register for the online talks click HERE.
Is migraine a progressive disease? Short answer in a subgroup it is.
With migraine, there is a line in the sand, but it isn’t firm, as we can wander back and forth. This line is Episodic migraine, less than 15 a month and Chronic migraine, greater than 15 a month.
Treatment for migraine involves lifestyle, acute treatments (triptans) and preventative treatments. With chronic migraine the goal is to improve overall functioning. Preventative treatments are considered at their Most effective at a 50% migraine frequency reduction.
Lipton has done a large study on who and why people go chronic as well as treatment of migraines. 25% percent of people with episodic migraines get minimal effective treatment for disabling migraines. This includes going to the doctor first, second getting the diagnosis correct and getting the proper treatment. It is substantially worse for chronic migraine where the criteria is a proper diagnosis, any guideline treatment, and any acute treatment. It found only 5% are getting minimally effective treatment. Lipton stated there is a lot of miscommunication about frequency when it comes to chronic migraineurs… attacks vs days. So I may have 9 attacks over the span of 15 days. Or have headaches I do not report because they are not ‘bad’ enough.
Lipton stated currently there are risk factors for progression from episodic to chronic and that the hope is to prevent progression. 2% of the population develop chronic migraine. Risk factors include such things as;
- having a high frequency to begin with,
- having Allodynia,
- Migraine overuse headaches,
- Using acute treatments that do not work well,
- Comorbid conditions; depression, anxiety, IBS, pain disorders, RLS
They know the risk factors but do not know if prevention helps with progression. Although it is a good idea to go on preventives, address lifestyle issues like problems with sleep, address comorbids and have a stress management plan.
The general progression with age is that migraines pick up around, especially in women hitting puberty. They peak in the 40s. Worse during menopause for women. And then often remits in middle age to later life. However chronic migraine there is a greater risk that migraine will persist into later life. Then the little fact that menopause is no guarantee that migraine will decrease after it is all said and done, but it Can have that result.
So it is progressive in the subset of people. That 2%ers that progress into chronic migraine. Why is not clear. Although it was stated it tends to run in families and there may be genetic links.