Current Pain and Headache Reports

, Volume 15, Issue 1, pp 57–63 | Cite as

Mechanism of Chronic Migraine

  • Sheena K. Aurora
  • Arun Kulthia
  • Patricia M. Barrodale
Article

Abstract

Chronic migraine typically evolves from episodic migraine over months to years in susceptible individuals. Headaches increase in frequency over time, becoming less intense but more disabling and less responsive to treatment. Results of electrophysiologic and functional imaging studies indicate that chronic migraine is associated with abnormalities in the brainstem that may be progressive. Additionally, chronic migraine is associated with a greater degree of impairment in cortical processing of sensory stimuli than is episodic migraine, perhaps due to a more pervasive or persistent cortical hyperexcitability. These findings fit with the model of migraine as a spectrum disorder, in which the clinical and pathophysiological features of migraine may progress over time. This progression is postulated to result from changes in nociceptive thresholds and ensuing central sensitization caused by recurrent migraine in susceptible individuals, for whom a variety of risk factors have been described. This may lead to changes in baseline neurologic function between episodes of headache, evident not only in electrophysiologic and functional imaging studies, but also as an increase in depression, anxiety, nonhead pain, fatigue, gastrointestinal disorders, and other somatic complaints that may occur after years of episodic migraine. From the current research and migraine models, a conceptualization of chronic migraine, in which relatively permanent and pervasive central changes that warrant novel and tolerable treatments have occurred, is emerging. This model also implies that prevention of chronic migraine is an important goal in the management of episodic migraine, particularly in individuals who exhibit risk factors for chronic transformation.

Keywords

Chronic migraine Imaging Physiology Mechanism 

Notes

Disclosures

Dr. Sheena K. Aurora has received grants and/or research support received from Advanced Bionics, Alexza Pharmaceuticals, Allergan, CAPNIA, Inc., GlaxoSmithKline, MAP Pharmaceuticals, Merck and Co., Ortho-McNeil Pharmaceutical, Inc., Neuralieve, NuPathe, and Takeda Pharmaceuticals; has served as a consultant for Ortho-McNeil Pharmaceutical, Inc., Medtronic, Merck and Co., GlaxoSmithKline, Allergan, Neuralieve, NuPathe, and MAP Pharmaceuticals; and has received honoraria from Merck and Co., GlaxoSmithKline, Kowa Pharmaceuticals, NuPathe, Ortho-McNeil Pharmaceutical, Inc., and Zogenix.A. Kulthia: none; P. Barrodale: none.

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Sheena K. Aurora
    • 1
  • Arun Kulthia
    • 1
  • Patricia M. Barrodale
    • 1
  1. 1.Swedish Headache Center, Swedish Neurosciences InstituteSeattleUSA

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