Why does Migraine become Chronic?

Why is it that some people start with the occasional migraine attack – and then months or years later they’re having an attack every other day – or worse? Is there some way to stop this from happening? Can it be reversed?

There have been some studies that point out “risk factors” for “chronification” of migraine. That doesn’t mean that the factor causes the attacks to become chronic necessarily. In fact, we really have very little understanding of what is happening, in spite of what you may have heard.

We do know that women tend to end up with chronic migraine more than men – however, it does affect everyone.

Some possible risk factors include:

• GENETICS
• Poor treatment (including ineffective medications, or using “too much” medication)
• Depression
• Physical trauma (brain injury)
• Emotional/mental trauma (a history of abuse)
• obesity
• Sleep disorders (sleep apnea, snoring)

I shouted out genetics at the start there, because that may actually be the biggest key factor. In other words, no matter what the other risk factors may be, some people will get it, some won’t.

Medication overuse is a commonly cited factor. But it’s very tricky – is the medication causing more attacks (this does seem to happen), or is the patient taking more medication because of more attacks?

Either way, it’s important to get the best treatment available before your attacks start increasing, to avoid this outcome.

The other factors above are difficult, though providing treatment for each factor may help with migraine (counselling? diet?)

Chronification may also be a result of another underlying disease, which is why you need to talk to your doctor if you see your migraine attacks increasing. For example, idiopathic intracranial hypertension (IIH) is suprisingly common in chronic migraine patients. If there are no obvious IIH symptoms, it’s easy to write off the problem as chronic migraine (researchers in Italy expressed concern about this a couple of years ago).

Besides seeing your doctor as soon as possible, what else can you do if your migraine attacks are becoming chronic?

Obviously your doctor can help you with specific treatments and preventative medications. There may be medications that you’ve taken in the past that you now need to replace with something else to break the cycle. You may also find that you’re suffering from more than one type of headache.

Secondly, pay attention to the risk factors above. If you need treatment for depression, obesity, a sleep disorder – these should be treated along with the chronic migraine.

I appreciated Dr. William Young’s top recommendation in his talk at the World Migraine Summit. Recognizing the severe disability some people experience with chronic migraine and daily headache, he said this:

Just my personal take, recently I’ve become more and more convinced that movement is key and that patients whose migraines are so severe it hurts to move and then they stop, they have got to do something. They should walk a half an hour a day. If they can’t, they should walk 10 minutes three times a day. If they can’t do that, they should walk three minutes 10 times a day.

Yes, if you can’t do anything else, walk for three minutes 10 times a day. Even that may seem overwhelming, but I agree with Dr. Young that this is critical – get moving. Even if you start with three minutes the first day, and four the next.

Although we’re not sure of all the reasons why migraine becomes chronic, we do know that it’s common – 1-2% of the general population, and about 8% of patients with migraine. And we do know that it can be reversed – there is lots of hope for anyone with chronic migraine that you’ll experience major improvement with the right treatment.

For more information, see Chronic migraine: risk factors, mechanisms and treatment. and Migraine “Chronification”: What You Can Do (pdf file)