Mechanism of Chronic Migraine

Authors: Sheena K Aurora Arun Kulthia Patricia M Barrodale

Publish Date: 2011/01/04

Volume: 15, Issue: 1, Pages: 57-63

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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 Results of electrophysiologic and functional imaging studies indicate that chronic migraine is associated with abnormalities in the brainstem 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 electrophysiologic 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 in which relatively permanent and pervasive central changes that warrant novel and tolerable treatments have occurred is emerging 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 transformationDr Sheena K Aurora has received grants and/or research support received from Advanced Bionics Alexza Pharmaceuticals Allergan CAPNIA Inc GlaxoSmithKline MAP Pharmaceuticals Merck and Co OrthoMcNeil Pharmaceutical Inc Neuralieve NuPathe and Takeda Pharmaceuticals has served as a consultant for OrthoMcNeil Pharmaceutical Inc Medtronic Merck and Co GlaxoSmithKline Allergan Neuralieve NuPathe and MAP Pharmaceuticals and has received honoraria from Merck and Co GlaxoSmithKline Kowa Pharmaceuticals NuPathe OrthoMcNeil Pharmaceutical Inc and ZogenixA Kulthia none P Barrodale none

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