Chronic Migraine Overview

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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.1

What is Chronic Migraine?

In the simplest of terms, chronic migraine (CM) is headache occurring on 15 or more days per month for more than 3 months, which has the features of migraine headache on at least 8 days per month.2

For diagnosing and classifying migraine and other headache disorders, the International Headache Society’s (IHS) International Classification of Headache Disorders, 3rd Edition (ICHD-III), is considered the gold standard. In 2013, they revised the guidelines with this criteria for chronic Migraine:

1.3 Chronic migraine2

A. Headache (tension-type-like and/or migraine-like) on ≥15 days per month for >3 months and fulfilling criteria B and C

B. Occurring in a patient who has had at least five attacks fulfilling criteria B-D for 1.1 Migraine with- out aura and/or criteria B and C for 1.2 Migraine with aura

C. On ≥8 days per month for >3 months, fulfilling any of the following:

1. Criteria C and D for 1.1 Migraine without aura

2. Criteria B and C for 1.2 Migraine with aura

3. Believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative

D. Not better accounted for by another ICHD-3 diagnosis.

 


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:3
    • 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:4

  • 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 headaches that occur on 15 or more days per month for more than 3 months, which has the features of migraine headache on at least 8 days per month. Both the burden of living with and the stigma associated with chronic migraine are even more significant that that of episodic migraine.

 

How would you define chronic migraine?
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