What predicts the change from episodic to chronic migraine?
OBJECTIVE
Because migraine worsens in a sizeable subgroup of sufferers, but not in most, identifying factors that predict the change from episodic into chronic migraine is of extreme interest and should be seen as a priority in headache research.


RESULTS
Potentially remediable risk factors include frequency of migraine attacks, obesity, excessive use of medications containing opioids and barbiturates, caffeine overuse, stressful life events, depression, sleep disorders and cutaneous allodynia.


CONCLUSIONS
While we wait for evidence regarding the benefits of risk factor modifications in the prevention of chronic migraine, several interventions are justifiable based on their other established benefits. For example, decreasing headache frequency with behavioral and pharmacological interventions will decrease current disability even if it does not modify clinical course. Monitoring the body mass index and encouraging maintenance of normal body weight is good practice in patients with and without migraine. Avoiding overuse of caffeine is desirable apart from its potential benefit in preventing progression. Sleep problems should be investigated and treated. Psychiatric comorbidities should be identified and addressed. Medications containing opioids and barbiturates should be reserved for a few selected cases of migraine, and their use should be monitored. For these interventions, the possibility of preventing progression may motivate clinicians to offer good care and patients to engage in the treatment plan.
Bigal
Marcelo E
ME
Merck Research Laboratories, Merck, Inc., Whitehouse Station, New Jersey, USA. marcelo_bigal@merck.com
Lipton
Richard B
RB
D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D002110:Caffeine / Q000009:adverse effects / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D015897:Comorbidity; D018450:Disease Progression; D006801:Humans; D001523:Mental Disorders / Q000150:complications; D008881:Migraine Disorders / Q000188:drug therapy / Q000503:physiopathology*; D009765:Obesity / Q000150:complications; D010146:Pain / Q000503:physiopathology; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications; D013315:Stress, Psychological / Q000150:complications
D000700:Analgesics; D000697:Central Nervous System Stimulants; D002110:Caffeine