Once migraine becomes chronic and has transformed into a form of headache that occurs daily or almost, the treatment options available are few and complex. This makes it important to take action before this point is reached, using all the measures that can be obtained from our current knowledge of chronic migraine (or transformed migraine) on the one hand, and on the potential factors of chronification (or transformation) on the other. Therefore, in order to reduce the risk of migraine chronification, it would appear important to: (a) administer suitable preventive treatments for subjects who have been suffering from migraines  654 days a month for  653 months; (b) take special care not to overuse symptomatic medications, particularly when they contain substances with a sedative effect; and (c) investigate the concomitant presence of depression, hypertension and excess weight and administer appropriate treatment when presen

A Proietti Cecchini

AI Scher

AM Rapoport

C Couppé

C. Camarda

G Nappi

G Sandrini

GC Manzoni

Gian Camillo Manzoni

Headache Classification Committee of the International Headache Society

Headache Classification Subcommittee of the International Headache Society

J Olesen

JR Saper

MC Tonini

ME Bigal

NT Mathew

P Torelli

P. Torelli

R Simone De

RB Lipton

SD Silberstein

T Ferrante

Z Katsarava

MANZONI, Gian Camillo

TORELLI, Paola

Camarda C

Archivio istituzionale della Ricerca -  Università degli Studi di Parma

Chronification of migraine: what clinical strategies to combat it?

Crossref

Neurological Sciences

Once migraine becomes chronic and has transformed into a form of headache that occurs daily or almost, the treatment options available are few and complex. This makes it important to take action before this point is reached, using all the measures that can be obtained from our current knowledge of chronic migraine (or transformed migraine) on the one hand, and on the potential factors of chronification (or transformation) on the other. Therefore, in order to reduce the risk of migraine chronification, it would appear important to: (a) administer suitable preventive treatments for subjects who have been suffering from migraines ≥4 days a month for ≥3 months; (b) take special care not to overuse symptomatic medications, particularly when they contain substances with a sedative effect; and (c) investigate the concomitant presence of depression, hypertension and excess weight and administer appropriate treatment when presen

Manzoni, GC

Torelli, P.

CAMARDA, Cecilia

Archivio istituzionale della ricerca - Università di Palermo

PECULIAR CLINICAL ASPECTS OF MIGRAINEChronification of migraine: what clinical strategies to combat it?Gian Camillo Manzoni • C. Camarda •P. Torelli Springer-Verlag Italia 2013Abstract Once migraine becomes chronic and hastransformed into a form of headache that occurs daily oralmost, the treatment options available are few and com-plex. This makes it important to take action before thispoint is reached, using all the measures that can beobtained from our current knowledge of chronic migraine(or transformed migraine) on the one hand, and on thepotential factors of chronification (or transformation) onthe other. Therefore, in order to reduce the risk of migrainechronification, it would appear important to: (a) administersuitable preventive treatments for subjects who have beensuffering from migraines C4 days a month for C3 months;(b) take special care not to overuse symptomatic medica-tions, particularly when they contain substances with asedative effect; and (c) investigate the concomitant pres-ence of depression, hypertension and excess weight andadminister appropriate treatment when present.Keywords Migraine  Migraine without aura Chronic migraine  Transformed migraine Chronification factorsIntroductionIn most cases, the natural history of migraine without aura(MO) follows a favourable trend, with a reduction in thefrequency and severity of attacks until, in some cases, theydisappear completely, often many years after onset andusually after the age of 50–55 years [1].Conversely, over the years, a minority of subjects suf-fering from MO experiences a gradual worsening, partic-ularly as regards the frequency of the attacks, whicheventually leads to the regular presence of headaches morethan 15 days every month, if not every day or almost. Inthese cases, we talk about chronic migraine (CM) ortransformed migraine (TM).From the very first reports of this possible worseningevolution of MO, the attention of researcher was, quiterightly, focussed on identifying the factors for the trans-formation of MO into CM or TM. In other words, it wasimmediately clear how important it was in order tounderstand why some subjects, unlike the majority, expe-rience chronification rather than a remission of their MO,to investigate the existence of potentially negative prog-nostic elements, by performing comparative analyses onlarge case series. This type of research constitutes theessential bases for being able to organise adequate strate-gies to treat or, better still, prevent CM or TM.In order to be able to debate this issue in a completemanner and succeed in identifying the ways in which MOchronification can be avoided, we first need to consider, ona one-by-one basis, the protagonists of the case—MO, CMor TM—and the potential factors of transformation, eval-uating what we know for sure and what we can suggest fora better and clinically more tangible definition of them.Migraine without auraSince the International Headache Society (HIS) publishedits classification in 1988 [2], at least as regards theG. C. Manzoni (&)  P. TorelliDepartment of Clinical and Experimental Medicine,University Hospital, University of Parma, Padiglione Barbieri,3 piano, Via Gramsci, 14, 43126 Parma, Italye-mail: giancamillo.manzoni@unipr.itC. CamardaDepartment of BioNeC, University of Palermo, Palermo, Italy123Neurol Sci (2013) 34 (Suppl 1):S57–S60DOI 10.1007/s10072-013-1377-xcharacterisation of the individual attacks, MO has had auniversally accepted position and set of diagnostic criteria.As further evidence of this, it did not undergo any variationin the subsequent edition, issued in 2004 (ICHD-II) [3]. Inthese classifications, MO is included as a migraine subtype(code 1) with a second diagnostic level (code 1.1), with nofurther subdivision.A third diagnostic level for MO was recently proposed[4, 5] based on the frequency of attacks, more specificallyaccording to the number of migraine days per month,According to which the code 1.1.1 refers to MO that occursless than 4 days a month (infrequent MO), code 1.1.2indicates MO that involves between 4 and 9 migraine daysper month (frequent MO), and code 1.1.3 MO that presents10–20 days a month (CM or very frequent MO).This subdivision has a corresponding treatment plan tobe followed: subjects with infrequent MO can be treatedwith symptomatic therapy alone, those with frequent MOmust have preventive therapy, whilst continuing to taketheir current symptomatic therapy, provided it is effica-cious and well tolerated and patients with CM (or veryfrequent MO) must follow preventive therapy and shouldchange their symptomatic treatment, even when it is effi-cacious, to avoid running the risk of worsening their MOdue to overuse.The utility of a classification that considers the fre-quency with which MO presents, making a distinctionbetween the various levels of progressive ‘‘severity’’, isfurther iterated by the fact that high attack frequencyconstitutes a prognostic element that is predictive of MOchronification [6, 7].Chronic migraine and/or transformed migraineAlthough with MO we are well aware of what we aretalking about, the same consensus does not exist for CMand TM. The current edition of the International Classifi-cation of Headache Disorders (ICHD-IIR del 2006) [8]resolves the issue by adopting the term CM with corre-sponding diagnostic criteria that are significantly differentfrom those formulated in the ICHD-II published in 2004.Neither classification makes any reference to the term TMintroduced by Mathew et al. [9] in the 1980s and subse-quently widely adopted thanks to its practical classificationand simple definition by Silberstein et al. [10].In our recent proposal for a review of the migraineclassification, mentioned in the previous paragraph, inwhich MO is split into three subtypes according to thenumber of migraine days per month, TM is considered acomplication of migraine [4, 5, 11]. In this way, CM is avery frequent MO that maintains all the clinical charac-teristics typical of migraine, whereas TM is a form of MOthat is modified (i.e. complicated) with respect to the pastnot merely because the number of headache days permonth is higher than that of CM, but also because theheadache does not present the aspects typical of migraine.This makes TM a more severe form and one that is moredifficult to treat than CM, the latter being more likely torevert to frequent or infrequent MO than TM [7, 12].The terms ‘‘chronic’’ and ‘‘chronification’’ are ambigu-ous and misleading. We believe that they should be disre-garded and the terms ‘‘very frequent MO’’ (code 1.1.3) and‘‘TM’’ (code 1.5.1) used instead, with the correspondingdiagnostic criteria listed in Table 1. If we really want tokeep the term CM, which it would appear that certainTable 1 Proposed revision of migraine classification, and proposeddiagnostic criteria for the three migraine without aura subtypes, andfor transformed migraine1.1 Migraine without aura1.1.1 Infrequent migraine without aura1.1.2 Frequent migraine without aura1.1.3 Very frequent migraine without aura1.1.3.1 With medication overuse1.1.3.2 Without medication overuse1.5 Complications of migraine1.5.1 Transformed migraine1.5.1.1 With medication overuse1.5.1.2 Without medication overuse1.1.1 Infrequent migraine without auraDiagnostic criteriaA. headache fulfilling criteria C and D for 1.1 migraine withoutaura on B3 days/month for C3 monthsB. Not attributed to another disorder1.1.2 Frequent migraine without auraDiagnostic criteriaA. headache fulfilling criteria C and D for 1.1 migraine withoutaura on [3 but \10 days/month for C3 monthsB. Not attributed to another disorder1.1.3 Very frequent migraine without auraDiagnostic criteriaA. Headache fulfilling criteria C and D for 1.1 migrainewithout aura on C10 but B20 days/month for C3 monthsB. Not attributed to another disorder1.5.1 Transformed migraineDiagnostic criteriaA. Headache (tension-type and/or migraine) on [20 days/month for C1 year and never with more than 5 consecutiveheadache-free daysB. Occurring in a patient who has had at least five attacksfulfilling criteria for 1.1 migraine without auraC. On C10 days/month for C1 year, headache has fulfilledcriteria for pain and associated symptoms of migraine withoutaura or patient has been successfully treated with an ergot ortriptanD. Not attributed to another disorderS58 Neurol Sci (2013) 34 (Suppl 1):S57–S60123authors are reluctant to give up, it could be used to definevery frequent MO, but not TM, which can no longer beconsidered a simple migraine, rather a fully blown compli-cated migraine. In any case, what does not seem clinicallyacceptable is to contemplate including under the currentsingle denomination of CM as defined by the ICHD-IIR [8],patients with such a difference in gravity as to warrant asubdivision into two well-defined groups: very frequent MO(or CM, if we wish) on the one hand, and TM on the other.Potential factors of chronification/transformationRegardless of whether we want to call it chronification ortransformation, the important thing is to try and identifythose factors, situations and any concomitant conditionsthat could favour a progression from MO towards CM oreven TM.Mathew et al. [9] identified overuse of symptomaticmedications, depression, hypertension and surgical meno-pause as elements that are often present when MO trans-forms into TM.Since then, several studies have dealt with the subjectand further elements have been added [13–16], althoughsome of them may appear dubious and need to be con-firmed or refuted by further specific research, and to datethe factors originally suggested by Mathew et al. [9]remain those most widely accepted.Of the factors identified more recently, the potential roleof obesity [17, 18] and cerebral venous sinus alterations[19] are undoubtedly of particular interest.A comparative analysis [7] that we recently conductedbetween (a) a group of patients who at first observationpresented with MO that either remained such, improved orcompletely disappeared over time and (b) a group ofpatients, similar to the first, originally affected by MO butthat, over the years, evolved towards CM or TM, showsthat a high frequency of attacks in both men and womenand depression in men at first observation, i.e. when thediagnosis was still one of ‘‘simple’’ MO, constitute factorspredictive of chronification/transformation. In addition,there is statistically significant evidence that depression inwomen and hypertension in both sexes, even when notpresent at first observation, tends to present in MO patientsevolving towards CM/TM more frequently than in MOpatients who either remain stable or improve over time.Strategies for combatting the chronification/transformation of MODespite all the limits due to (a) a clinical classification ofCM/TM that is not yet unanimously accepted and (b) anas yet incomplete and uncertain identification of thepotential negative prognostic factors in the natural his-tory of MO, at the current state of knowledge, it wouldappear possible and useful to adopt measures aimed atpreventing the chronification of MO. The great impor-tance of this operation derives also from the consider-able difficulties of treating CM/TM once it is established[20, 21].The first action to be taken is to treat MO while there isstill time—‘‘before the horse has bolted’’ [22], so to speak.For this to be plausible, we should take into considerationthe data produced by an epidemiological study conductedin the USA [23], according to which unfortunately, just6–7 % of subjects with MO in the general populationconsults a doctor and receives a correct diagnosis, suitabletreatment and regular follow-up. This highlights theimportance of transmitting adequate and correct informa-tion on migraine to both general practitioners and patients[24]. Treating MO whilst there is still time means makinguse, in those subjects who regularly suffer more than 3migraine days a month, not merely of the necessarysymptomatic medications, but above all, all the possiblepreventive treatments available, which, fortunately, arenow fairly numerous.Correct use of prophylactic treatments can also con-tribute to a better approach to the second important step inpreventing MO chronification: avoiding overuse of symp-tomatic medications which, as has been extensively pro-ven, can create a vicious circle of dependency andaddiction, with a progressive worsening in the migrainesituation [25]. Since the highest risk symptomatic medi-cations in this sense are products containing a combinationthat also includes substances with a sedative action [26], itwould appear appropriate for very frequent MO patients,until such time as they benefit from the preventive treat-ments prescribed, to avoid or at least limit the use of thistype of symptomatic medication and also seek psycholog-ical support.The third, fundamental measure for reducing the risk ofchronification consists in dedicating the greatest possiblecare to the existence of potential comorbidities. Although ithas been known for some time that certain conditionspresent more frequently in MO subjects [27, 28] and othershave been identified more recently, not all the potentialcomorbidities of MO favour chronification. As far as weknow at the current time, the highest-risk conditions aredepression [9, 29], hypertension [9] and excess weight [17,18]. As far as possible, these should be prevented in MOsubjects and where they are already present, they requireparticularly careful treatment. In this sense, the fact that themedications that provide efficacious prophylaxis for MOalso include antihypertensives and antidepressants mayconstitute an advantage.Neurol Sci (2013) 34 (Suppl 1):S57–S60 S59123Conflict of interest We certify that there is no actual or potentialconflict of interest in relation to this article.References1. Ferrante T, Castellini P, Abrignani G, Latte L, Russo M, CamardaC, Veronesi L, Torelli P, Pasquarella C, Manzoni GC (2012) ThePACE study: past-year prevalence of migraine in Parma’s adultgeneral population. Cephalalgia 32:358–3652. Headache Classification Committee of the International Head-ache Society (1988) Classification and diagnostic criteria forheadache disorders, cranial neuralgias and facial pain. Cepha-lalgia 8(Suppl 7):1–963. Headache Classification Subcommittee of the InternationalHeadache Society (2004) The international classification ofheadache disorders—2nd edn. Cephalalgia 24(Suppl 1):1–1604. Manzoni GC, Bonavita V, Bussone G, Cortelli P, Narbone MC,Cevoli S, D’Amico D, De Simone R, Torelli P (2011) Chronicmigraine classification: current knowledge and future perspec-tives. J Headache Pain 12:585–5925. Torelli P, Manzoni GC (2012) A redefinition of primary head-ache: chronic migraine. Neurol Sci 33:S17–S206. Bigal ME, Rapoport AM, Sheftell FD, Tepper SJ, Lipton RB(2005) Chronic migraine is an earlier stage of transformedmigraine in adults. Neurology 65:1556–15617. Manzoni GC, Lombardi LL, Lana S, Maffezzoni M, Camarda C,Torelli P (2012) Detection of possible factors favouring theevolution of migraine without aura into chronic migraine. NeurolSci 33:S165–S1678. Olesen J, Bousser MG, Diener HC, Dodick D, First M, GoadsbyPJ, Goebel H, Lainez MJA, Lance JW, Lipton RB, Nappi G,Sakai F, Schoenen J, Silberstein SD, Steiner TJ (2006) Newappendix criteria open for a broader concept of chronic migraine.Cephalalgia 26:742–7469. Mathew NT, Reuveni U, Perez F (1987) Transformed or evolu-tive migraine. Headache 27:102–10610. Silberstein SD, Lipton RB, Solomon S, Mathew NT (1994)Classification of daily and near-daily headaches: proposed revi-sions to the HIS criteria. Headache 34:1–711. Manzoni GC, Torelli P (2012) New prospects in the taxonomicclassification of primary headaches. Neurol Sci 33:S13–S1612. Manzoni GC, Grisendi I, Torelli P (2011) ICHD-3: what changesdo we need regarding migraine? Curr Pain Headache Rep 15:170–17613. Lipton RB, Bigal ME (2005) Migraine: epidemiology, impact,and risk factors for progression. Headache 45(Suppl 1):S3–S1314. Bigal ME, Lipton RB (2006) Modifiable risk factors for migraineprogression. Headache 46:1334–134315. Scher AI, Lipton RB, Stewart W (2002) Risk factors for chronicdaily headache. Curr Pain Headache Rep 6:486–49116. Katsarava Z, Schneeweiss S, Kurth T, Kroener U, Fritsche G,Eikermann A, Diener HC, Limmroth V (2004) Incidence andpredictors for chronicity of headache in patients with episodicmigraine. Neurology 62:788–79017. Bigal ME, Gironda M, Tepper SJ, Feleppa M, Rapoport AM,Sheftell FD, Lipton RB (2006) Headache prevention outcome andbody mass index. Cephalalgia 26:445–45018. Bigal ME, Lipton RB, Biondi D, Xiang J, Hulihan J (2009)Weight change and clinical markers of cardiovascular diseaserisk during preventive treatment of migraine. Cephalalgia 29:1188–119619. De Simone R, Ranieri A, Bonavita V (2010) Advancement inidiopathic intracranial hypertension pathogenesis: focus on sinusvenous stenosis. Neurol Sci 31(Suppl 1):S33–S3920. Sandrini G, Perrotta A, Tassorelli C, Torelli P, Brighina F, SancesG, Nappi G (2011) Botulinum toxin type—a in the prophylactictreatment of medication-overuse headache: a multicenter, double-blind, randomized, placebo-controlled, parallel group study.J Headache Pain 12:427–43321. Proietti Cecchini A, Leone M, Manzoni GC, Torelli P, Bussone G(2012) Drug-resistant chronic migraine: the Italian GON project.Neurol Sci 33:S13–S1622. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, StewartWF (2007) Migraine prevalence, disease burden, and the need forpreventive therapy. Neurology 68:343–34923. Lipton RB, Stewart WF, Simon D (1998) Medical consultationfor migraine: results from the American Migraine Study. Head-ache 38:87–9624. Nappi G, Jensen R, Nappi RE, Sances G, Torelli P, Olesen J(2006) Diaries and calendars for migraine. A review. Cephalalgia26:905–91625. Rapoport AM (1988) Analgesic rebound headache. Headache28:662–66526. Saper JR, Hamel RL, Lake AE (2005) Medication overuseheadache (MOH) is a biobehavioural disorder. Cephalalgia25:545–54627. Tonini MC, Giordano L, Atzeni L, Bogliun G, Perri G, SaraccoMG, Tombini M, Torelli P, Turazzini M, Vernieri F, Aguggia M,Bussone G, Beghi E (2012) Primary headache and epilepsy: amulticenter cross-sectional study. Epilepsy Behav 23:342–34728. Couppe´ C, Torelli P, Fuglsang-Frederiksen A, Andersen KV,Jensen R (2007) Myofascial trigger pints are very prevalent inpatients with chronic tension-type headache: a double-blindedcontrolled study. Clin J Pain 23:23–2729. Torelli P, Lambru G, Manzoni GC (2006) Psychiatric comor-bidity and headache: clinical and therapeutical aspects. NeurolSci 27:S73–S76S60 Neurol Sci (2013) 34 (Suppl 1):S57–S60123

https://iris.unipa.it/retrieve/handle/10447/77465/82708/Chronification%20of%20migraine%20%20what%20clinical%20strategies%20to%20combat%20it.pdf

Chronification of migraine: what clinical strategies to combat it?

Abstract

Similar works

Full text

Available Versions

Archivio istituzionale della Ricerca - Università degli Studi di Parma

Crossref

Archivio istituzionale della ricerca - Università di Palermo