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Chronic Migraine (Transformed Migraine)

Transformed migraine (TM) is a migraine condition that initially began as episodic migraine attacks, which then increase in frequency over a period of month to years. Transformed migraines occur daily or almost daily and appear to be a mixture of tension-type headaches and migraine attacks. The pain associated with transformed migraines often drops to a mild to moderate level of severity. Patients with TM often have a history of episodic migraines originating in the early teens or twenties. The process of transformation yields attacks that are frequently accompanied by phonophobia, photophobia, and nausea, but these symptoms tend to lessen in severity and frequency over time. Many other symptoms of migraine remain, such as unilateral pain, gastrointestinal symptoms, as well as aggravation by other triggers. Many of the patients with TM are women, 90% of whom have a history of migraine without aura.

Transformed migraines often have a vascular quality, exhibiting a throbbing nature to those afflicted. In some cases, it can be difficult to distinguish between tension-type headaches and TM. Patients may report a sudden or gradual change to headaches of lesser severity but greater frequency. This change may be related to a variety of factors (see below). Clinical studies have shown that nearly 80% of CM patients overuse symptomatic medications. Medication over-use can increase the frequency of migraine occurrence. Daily use of analgesics, either prescription or over-the-counter, can place the patient at greater risk for development of Medication Overuse Headache (MOH), also known as Rebound Headache.

Other risk factors for transformation from episodic to chronic migraine include:

  • Attack frequency (having more than 1 headache attack per week increases the risk to transform)
  • Acute medication overuse –discussed above
  • Duration of disease – the longer you have suffered from headaches, the more likely to transform
  • Obesity and snoring – increase the risk of transforming
  • Stressful life events such as marriage problems, busy life and difficult job
  • Female gender
  • Low education and socioeconomic status
  • Head injury

Some of these risk factors, such as obesity and medication overuse, are modifiable. By addressing these issues, you may help reduce your risk of TM.

Chronic migraineurs frequently experience symptoms of depression and anxiety. Some studies have shown that nearly 80% of patients with CM have depression. Addressing the mental health issues is part of the overall treatment plan.

Treatment of transformed migraines remains difficult and often requires consultation with a specialist. Analgesic medications must be limited to avoid MOH. Healthy lifestyle habits including sleeping, eating and exercising are important. Working with a counselor for pain management and coping skills for those stressful life events can improve the outcome. A variety of preventive therapies including Antidepressant and Anticonvulsant medications are used. The goal in management of transformed migraine is to revert the headaches back from daily to episodic attacks.

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