For many, attacks of migraine occur infrequently and are responsive to medication. However, for others, the headache patterns have changed over time. Well-defined attacks of migraine are mixed with other less severe but more frequent headaches. Eventually, a person may begin to feel headache prone, feeling that a headache is always lurking just around the corner even when a headache is not present. Finally, the different patterns of headache merge into what has been described as a mixed headache pattern, where frequent low-grade headaches intermingle with bouts of severe migraines. This pattern, in turn, can evolve into another disabling headache pattern called chronic migraine, also known as chronic daily headache or transformed migraine.
The term episodic migraine applies when someone has migraine less than 15 days a month. Chronic migraine is defined as having more than 15 headache days a month for 3 months. Those headaches must be 8 migraines or headaches that respond to migraine specific medication; 7 of the headaches can be tension-type headache or probable migraine.
Even though transformation may be part of the natural evolution of migraines, certain catalysts also seem to play a role. Facilitation or kindling describes the impact of repeated attacks of migraine without adequate treatment. These uncontrolled attacks may actually prime the pump and lower the “threshold” for future migraines. In other words, uncontrolled migraine may pave the way for more migraine attacks in the future. The physicians at Headache Care Center are committed to helping you gain control over acute migraine attacks.
Another important catalyst is trauma to the head or neck. Even minor trauma can cause microscopic disruption of information pathways to the nervous system and change intermittent migraines into chronic headaches. If a head or neck trauma seems to have worsened or initiated your migraines, discuss this association with your physician. There are treatments beyond medications, like physical therapy, that may be benefit you.
Emotional trauma can also be a factor. Divorce, death, losing a job, or any major lifestyle change can trigger an increase in headache frequency.
The third catalyst of migraine transformation is medication. Ironically, most medications that relieve an acute migraine attack may change an episodic migraine pattern into a chronic daily headache when taken frequently over a period of time. If the medication is stopped suddenly, a severe headache called a "rebound headache or medication overuse headache" may erupt. Review all medications you are taking, especially over-the-counter medications, herbal products, and vitamins with your doctor. Once an analgesic headache pattern is properly treated, daily headaches often return to intermittent migraines that are treatable with acute medication.
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