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Published on: June 2, 2014
Chronic Migraine Pathophysiology and Treatment: A Review of Current Perspectives
Tiffani J Mungoven1, Luke A Henderson1, Noemi Meylakh1
1Department of Anatomy and Histology, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
Abstract:
Chronic migraine is a disabling neurological disorder that imposes a considerable burden on individual and socioeconomic outcomes. Chronic migraine is defined as headaches occurring on at least 15 days per month with at least eight of these fulfilling the criteria for migraine. Chronic migraine typically evolves from episodic migraine as a result of increasing attack frequency and/or several other risk factors that have been implicated with migraine chronification. Despite this evolution, chronic migraine likely develops into its own distinct clinical entity, with unique features and pathophysiology separating it from episodic migraine. Furthermore, chronic migraine is characterized with higher disability and incidence of comorbidities in comparison to episodic migraine. While existing migraine studies primarily focus on episodic migraine, less is known about chronic migraine pathophysiology. Mounting evidence on aberrant alterations suggest that pronounced functional and structural brain changes, central sensitization and neuroinflammation may underlie chronic migraine mechanisms. Current treatment options for chronic migraine include risk factor modification, acute and prophylactic therapies, evidence-based treatments such as onabotulinumtoxinA, topiramate and newly approved calcitonin gene-related peptide or receptor targeted monoclonal antibodies. Unfortunately, treatments are still predominantly ineffective in aborting migraine attacks and decreasing intensity and frequency, and poor adherence and compliance with preventative medications remains a significant challenge. Novel emerging chronic migraine treatments such as neuromodulation offer promising therapeutic approaches that warrant further investigation. The aim of this narrative review is to provide an update of current knowledge and perspectives regarding chronic migraine background, pathophysiology, current and emerging treatment options with the intention of facilitating future research into this debilitating and largely indeterminant disorder.
Insights
Chronic migraine, a severe neurological disorder, differs from episodic migraine with unique pathophysiology and higher disability. Current treatments are often ineffective, highlighting the need for novel therapies like neuromodulation.
Area of Science:
- Neurology
- Neuroscience
Background:
- Chronic migraine is a disabling neurological disorder with significant individual and socioeconomic impact.
- It is defined by headaches on ≥15 days/month, with ≥8 meeting migraine criteria, often evolving from episodic migraine.
- Chronic migraine presents distinct pathophysiology, higher disability, and comorbidities compared to episodic migraine.
Purpose of the Study:
- To provide an updated review of chronic migraine.
- To discuss its background, pathophysiology, and current/emerging treatment options.
- To facilitate future research into this debilitating disorder.
Main Methods:
- This is a narrative review.
- It synthesizes current knowledge on chronic migraine.
- Focuses on pathophysiology and treatment modalities.
Main Results:
- Chronic migraine pathophysiology involves brain changes, central sensitization, and neuroinflammation.
- Current treatments (e.g., onabotulinumtoxinA, CGRP inhibitors) show limited efficacy and adherence challenges.
- Novel treatments like neuromodulation show promise.
Conclusions:
- Chronic migraine is a distinct entity requiring further research.
- Existing treatments are insufficient, necessitating exploration of new therapeutic avenues.
- Neuromodulation offers a promising future direction for chronic migraine management.
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