- Ivan Garza, MD
Ivan Garza, MD
- Assistant Professor of Neurology
- Mayo Clinic College of Medicine
- Todd J Schwedt, MD, MSCI
Todd J Schwedt, MD, MSCI
- Associate Professor
- Department of Neurology
- Mayo Clinic
Chronic daily headache is a descriptive term that encompasses several different specific headache diagnoses characterized by frequent headaches. Chronic daily headache types with individual headaches of long duration (ie, four hours or more) include chronic migraine, chronic tension-type headache, medication overuse headache, hemicrania continua, and new daily persistent headache.
This topic will discuss chronic migraine (previously known as transformed migraine). Other types of chronic daily headache are reviewed elsewhere. (See "Overview of chronic daily headache".)
The pathophysiology of migraine centers on the trigeminovascular system. This is discussed in detail separately. (See "Pathophysiology, clinical manifestations, and diagnosis of migraine in adults", section on 'Pathophysiology'.)
Although the pathophysiology of the transformation from episodic to chronic migraine is not well-understood, it is hypothesized that atypical pain processing, cortical hyperexcitability, neurogenic inflammation, and central sensitization are involved . Furthermore, in patients with migraine, functional and structural alterations in the brain have been identified that correlate with longer disease duration and increased headache frequency [2,3]. However, it is not clear whether these alterations lead to chronic migraine. They may be simply markers of transformation or secondary effects from frequent migraines.
Chronic migraine affects approximately 2 percent of the world population . It causes significant reductions in quality of life and is even more disabling than episodic migraine [5-8]. In addition, chronic migraine results in enormous expense to society. In the United States, the direct and indirect costs of migraine are estimated to be more than 20 billion dollars annually, and a significant proportion of this cost is attributable to chronic migraine .
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- Manack A, Buse DC, Serrano D, et al. Rates, predictors, and consequences of remission from chronic migraine to episodic migraine. Neurology 2011; 76:711.
- CLINICAL FEATURES
- Comorbid conditions
- - First-line agents
- - Second- and third-line agents
- - Choosing an agent
- Nonpharmacologic therapy
- - Avoidance of migraine triggers
- - Behavioral and physical therapy
- - Occipital nerve stimulation
- SUMMARY AND RECOMMENDATIONS