Are Episodic and Chronic Migraine One Disease or Two?
Related Experiment Video
Updated: Mar 31, 2026
3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
Published on: June 2, 2014
Reuben Burshtein1, Aaron Burshtein2, Joshua Burshtein3
1, 165 Main Pkwy West, Plainview, NY, 11803-2924, USA. BurshteinR@gmail.com.
Abstract:
Migraine is a debilitating headache disorder that has a significant impact on the world population, in both economic and sociologic capacities. Migraine has two main categories: (1) chronic migraine (CM), defined as the patient having 15 or more headache days per month, with at least five attacks fulfilling measures for EM with aura or EM without aura, and (2) episodic migraine (EM), defined as less than 15 headache days per month. With this definition, CM can only exist in the presence of EM, and it questions whether the two are separate diseases. Migraine has a significant impact on the population, as each year, about 2.5 % of patients with EM develop new-onset CM (Manack et al., Curr Pain Headache Rep 15:70-78, 2011) (Loder et al. Headache 55:214-228, 2015), with certain risk factors being evident only with CM. In addition, there are comorbid diseases that are only associated with CM, suggesting two separate diseases rather than one. Differentiation in response to treatments, both preventive and abortive, demonstrates both a similarity and a difference in EM versus CM. Also, comparing the two processes based upon functional imaging has been a recent development, beginning to show a physiological difference in regional cortical thickness, cortical surface area, and regional volumes in patients with EM and CM. Evidence regarding whether EM and CM demonstrate one disease with a significant level of complication or if two independent processes is inconclusive, and additional research must be performed to further characterize their relationship.
Insights
Episodic migraine (EM) and chronic migraine (CM) may be distinct conditions, not just different severities of the same headache disorder. Research shows differences in risk factors, comorbidities, treatment responses, and brain imaging between EM and CM.
Area of Science:
- Neurology
- Headache Medicine
Background:
- Migraine is a prevalent, debilitating neurological disorder impacting global health and economies.
- Migraine is broadly classified into episodic migraine (EM) and chronic migraine (CM), with CM defined by ≥15 headache days/month.
Purpose of the Study:
- To investigate whether episodic migraine (EM) and chronic migraine (CM) represent a single disease spectrum or two distinct pathological processes.
- To analyze the differentiating factors including risk factors, comorbidities, treatment responses, and neuroimaging findings between EM and CM.
Main Methods:
- Comparative analysis of epidemiological data, clinical characteristics, and treatment outcomes for EM and CM patients.
- Review of functional neuroimaging studies examining physiological differences in brain structure (cortical thickness, surface area, regional volumes) between EM and CM cohorts.
Main Results:
- Approximately 2.5% of EM patients transition to CM annually, with specific risk factors and comorbidities uniquely associated with CM.
- Treatment responses (preventive and abortive) show both similarities and distinctions between EM and CM.
- Functional imaging reveals physiological differences in cortical thickness, surface area, and regional brain volumes between EM and CM patients.
Conclusions:
- The distinct clinical features, risk factors, comorbidities, treatment responses, and neuroimaging findings suggest that EM and CM may be separate disease entities rather than points on a single continuum.
- Further research is essential to definitively characterize the relationship between EM and CM and inform clinical management strategies.
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