Chronic Migraine Overview

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Chronic Migraine Overview: Introduction

In the United States, there are more than 37 million people who have Migraines. Of those 37 million American Migraineurs, it’s estimated that between two and three million of them have chronic Migraine.⁴

What is chronic Migraine?

In the simplest of terms, chronic Migraine (CM) is having Migraines or tension-type headaches 15 or more days a month, which means that people with chronic Migraine have a Migraine or headache more often than not.

For diagnosing and classifying Migraine and other headache disorders, the International Headache Society’s (IHS) International Classification of Headache Disorders, 2nd Edition (ICHD-II), is considered the gold standard. In 2006, they revised the ICHD-II with this criteria for chronic Migraine:

Appendix 1.5.1 Chronic migraine¹

A. Headache (tension-type and/or migraine) on 15 or more days per month for at least 3 months

B. Occurring in a patient who has had at least five attacks fulfilling criteria for 1.1 Migraine without aura

C. On 8 or more days per month for at least 3 months headache has fulfilled C1 and/or C2 below, that is, has fulfilled criteria for pain and associated symptoms of migraine without aura

1. Has at least two of a–d

(a) unilateral location
(b) pulsating quality
(c) moderate or severe pain intensity
(d) aggravation by or causing avoidance of routine physical activity (e.g. walking or climbing stairs)

and at least one of a or b
(a) nausea and/or vomiting
(b) photophobia and phonophobia

2. Treated and relieved by triptan(s) or ergot before the expected development of C1 above

D. No medication overuse and not attributed to another causative disorder

Although it’s not part of the ICHD-II, most of the current working definitions of chronic Migraine also include that each headache or Migraine last at least four hours if not treated.

The burden and impact of chronic Migraine
Studies have revealed data about Chronic Migraine and the difference in the impact of Chronic Migraine when compared to that of episodic Migraine (EM):

Based on the MIDAS questionnaire (The Migraine Disability Assessment Test), the impact of Chronic Migraine is significantly greater than that of episodic Migraine EM.
Over a three-month period:⁵
- 8.2% of those with Chronic Migraine reported missing at least five days of work as compared to 2.2% of those with EM.
- 33.8% of those with Chronic Migraine reported at least five days of reduced productivity at work as compared to 2.2% of those with EM.
- 58.1% of those with Chronic Migraine reported at least five days of reduced productivity in household work as compared to 18.2% of those with EM.
- 36.9% of those with Chronic Migraine reported at least five days of missed family activities as compared to 9.5% of those with EM.

Chronic Migraine and stigma
In a study designed to “characterize stigma in patients with chronic and episodic Migraines, researchers found:⁶

Participants with Chronic Migraine scored higher on the Stigma Scale for Chronic Illness scale (SSCI) than participants with EM.
Participants with Chronic Migraine also scored significantly higher on the SSCI than a mixed panel of patients with chronic neurologic diseases; stroke, epilepsy, multiple sclerosis, Alzheimer’s, ALS and Parkinson’s disease.

Summary
Chronic Migraine is having Migraines and tension-type headaches 15 or more days per month for three months or longer. Of those 15 days, Migraines must occur on eight or more days and last four hours or longer if not treated. Both the burden of living with and the stigma associated with chronic Migraine are even more significant that that of episodic Migraine.

Written by: Teri Robert / Reviewed by: John-Claude Krusz, PhD, MD | Last review date: September 2011.

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Resources:

¹ Headache Classification Committee of the International Headache Society: J Olesen, M-G Bousser, H-C Diener, D Dodick, M First, PJ Goadsby, H Göbel, MJA Lainez, JW Lance, RB Lipton, G Nappi, F Sakai, J Schoenen, SD Silberstein & TJ Steiner. “Brief Report: New appendix criteria open for a broader concept of chronic migraine.” Cephalalgia, 2006, 26, 742–746.

² “The International Classification of Headache Disorders, 2nd Edition.” Cephalalgia 24 (s1). doi: 10.1111/j. 1468-2982.2003.00824.x

³ Silberstein, Stephen D., MD. “Managing Chronic Migraine in 2011: Background.” Medscape Neurology. April 18, 2011.

⁴ Natoli, JL; Manack, A; Dean, B; Butler, Q; Turkel, CC; Stovner, L.; and Lipton, R.B. “Global prevalence of chronic migraine: A systematic Review.” Cephalalgia 2010;30: 599. DOI: 10.1111/j.1468-2982.2009.01941.x.

⁵ Bigal ME, Serrano D, Reed M, Lipton RB. “Chronic migraine in the population: burden, diagnosis, and satisfaction with treatment.” Neurology. 2008;71(8):559-566. DOI 10.1212/01.wnl.0000323925.29520.e7.

⁶ Park J.E.1; Kempner J.2; Young W.B. “The Stigma of Migraine.” Poster presentation. 52nd annual meeting of the American Headache Society. Los Angeles. June, 2010.