High-frequency episodic migraine: Time for its recognition as a migraine subtype?

Area of Science:

• Neurology
• Headache Medicine

Background:

• High-frequency episodic migraine (HFEM) is increasingly recognized in headache research.
• This review assesses if HFEM is a distinct clinical or biological entity within the migraine spectrum.

Purpose of the Study:

• To evaluate the evidence supporting HFEM as a unique entity.
• To analyze literature on HFEM's clinical and biological characteristics.

Main Methods:

• A narrative review of 61 papers was conducted.
• Papers were categorized into socio-demographics, clinical/therapeutic aspects, pathophysiology, and classification.

Main Results:

• HFEM subjects differ in education, employment, quality of life, disability, and psychiatric comorbidities.
• Evidence suggests a unique profile of pain pathway activation in HFEM, potentially linked to maladaptive plasticity.

Conclusions:

• HFEM patients present a distinct clinical and socio-demographic profile with higher disease burden.
• HFEM carries an elevated risk of transitioning to chronic migraine.
• Recognizing HFEM as distinct can advance migraine understanding and public health strategies.