Chronic Migraine: Losing the Ability to Control Pain

Imagine that a system of levees or dikes had been built to control the flow of a certain river. Although no levee is perfect, it does provide a certain amount of safety from flooding. Flooding may still happen, but hopefully it will happen on a smaller scale.

But maybe these dikes were built long ago. Maybe they’re getting old, and they’re starting to let water through, not only when there’s a very unusual amount of water, but even when the water is just a little higher than normal.

Could that be a good analogy for chronic migraine?

A big area of study right now is the question of just how and why migraine disease goes from being episodic (an attack once in a while) to chronic (an attack every day or two). One of the studies published this month in The Journal of Headache Pain was focused on a certain aspect of chronic migraine.

Research focused on female migraine patients and their responses to pain when they were not in the middle of a migraine attack. This is very important, because migraine does involve changes in the body that are present whether someone is actually having a “migraine attack” or not.

In this case, sure enough, researchers found that there was a significant difference in “trigeminal pain processing” (how trigeminal (a certain type of nerve) pain was managed by the body) between patients with episodic migraine and patients with chronic migraine.

We know that migraine involves “hyperexcitability” – that is, the brain seems to over-react to stimuli. But this hyperexcitability seems to be different in different types of migraine, in this case chronic or episodic.

It could be that the brain’s natural mechanisms for controlling the flow of pain and other symptoms are actually impaired, or completely broken, in the case of chronic migraine. If so, is there a way to “repair the levees” and reduce the migraine attacks?

Many patients have successfully reduced their attacks. But the more we know about the actual function of chronic migraine and other chronic pain conditions, the more easily and quickly we’ll be able to fix the problem.

Study abstract: Differences in central facilitation between episodic and chronic migraineurs in nociceptive-specific trigeminal pathways.