Detection of possible factors favouring the evolution of migraine without aura into chronic migraine

Abstract

In a minority of cases, the natural history of migraine without aura (MO) is characterised over time by its evolution into a form of chronic migraine (CM). In order to detect the possible factors predicting this negative evolution of MO, we searched in our Headache Centre files for all clinical records that met the following criteria: (a) first visit between 1976 and 1998; (b) diagnosis of MO or of common migraine at the first observation, with or without association with other primary headache types; (c)\15 days per month of migraine at the first observation; and (d) at least one follow-up visit at least 10 years after the first visit. The patients thus identified were then divided into two groups based on a favourable/ steady evolution (Group A: n = 243, 195 women and 48 men) or an unfavourable evolution (Group B: n = 72, 62 women and 10 men) of their migraine over time. In the two groups, we compared various clinical parameters that were present at the first observation or emerged at the subsequent follow-up visits. The parameters that were statistically significantly more frequent in Group B-and can therefore be considered possible negative prognostic factors-were: (a) C10 days per month of migraine at the first observation; (b) presence of depression at the first visit in males; and (c) onset of depression or arterial hypertension after the first observation but before transformation to CM in females. Based on these findings, in MO patients the high frequency of migraine attacks, comorbidity with depression, and the tendency to develop arterial hypertension should require particular attention and careful management to prevent evolution into CM.

CGRP and PTX3 as Predictors of Efficacy of Onabotulinumtoxin Type A in Chronic Migraine: An Observational Study

“…Measurement of outcome is also inaccurate. Many studies have tried to find predictors of evolution and response to treatment in CM, but results have been inconsistent and mainly referred to clinical characteristics as localization, intensity, frequency of headache, or allodynia . As a result of this, treatment for a specific individual is frequently selected based on adverse effects and comorbidities.…”

Chronification of migraine: what clinical strategies to combat it?

“…The utility of a classification that considers the frequency with which MO presents, making a distinction between the various levels of progressive ''severity'', is further iterated by the fact that high attack frequency constitutes a prognostic element that is predictive of MO chronification [6,7].…”

“…complicated) with respect to the past not merely because the number of headache days per month is higher than that of CM, but also because the headache does not present the aspects typical of migraine. This makes TM a more severe form and one that is more difficult to treat than CM, the latter being more likely to revert to frequent or infrequent MO than TM [7,12].…”

“…A comparative analysis [7] that we recently conducted between (a) a group of patients who at first observation presented with MO that either remained such, improved or completely disappeared over time and (b) a group of patients, similar to the first, originally affected by MO but that, over the years, evolved towards CM or TM, shows that a high frequency of attacks in both men and women and depression in men at first observation, i.e. when the diagnosis was still one of ''simple'' MO, constitute factors predictive of chronification/transformation.…”

Migraine and Complex Regional Pain Syndrome: A Case-Referent Clinical Study

“…The annual rate of EM-to-CM progression is 2.5% [ 3 – 5 ] while the 2-yearly rate of CM-to-EM remission has been found to be 26% [ 6 , 7 ]. Some of the modifiable risk factors for EM-to-CM progression include medication overuse [ 3 ], obesity [ 8 ], hypertension [ 9 ], sleep-related problems (insomnia, habitual snoring, sleep bruxism, and daytime sleepiness) [ 10 ], psychiatric problems (depression, anxiety, and somatization disorders) [ 9 ], specific migraine features (increased headache frequency [ 11 ], allodynia [ 12 ], nausea [ 13 ], and prolonged headache duration [ 13 ]), chronic pain disorders [ 9 ], and caffeine consumption [ 14 ]. Nonmodifiable risk factors include female gender [ 15 , 16 ], older age groups [ 5 ], lower socioeconomic status [ 5 ], genetic background [ 17 ], stressful life events such as divorce or moving [ 18 ], and head and neck trauma [ 19 ].…”