The paradoxical effects of analgesics and the development of chronic migraine

Abstract

In a subgroup of individuals episodic migraine evolves into a stage where individuals have headaches on more days than not. Among the risk factors for chronification, excessive use of analgesic medications figure prominently and reviewing this topic is the scope of this article. The issue of causality is discussed and evidence suggesting that specific medications, at critical doses, are risk factors for chronic migraine (CM) is reviewed. The concept of critical dose of exposure for different classes is presented and biological plausibility and putative mechanisms are reviewed.

Migraine and Stroke: What’s the Link? What to Do?

“…Cerebral hyperemia is followed by prolonged cerebral oligaemia attributable to decreased vascular responsiveness [52]. Therefore, it may favor ischemic events in the brain [53]. In addition, in vulnerable tissue, severe hypoperfusion may follow CSD, consequently leading to enlargement of ischemic lesion [54].…”

“…In addition, in vulnerable tissue, severe hypoperfusion may follow CSD, consequently leading to enlargement of ischemic lesion [54]. Mice with human migraine mutations represent an increased vulnerability to CSD and cerebral ischemia [37, 53]. It may be speculated that CSD could be the mechanism causing the ischemic lesion in the vulnerable brain.…”

Evidence-Based Treatments for Adults with Migraine

“…A subset of patients progresses from having episodic migraine (EM) to chronic migraine (CM), the latter affecting 1%-2% of the population [ 3 ]. This is a gradual process, initially changing from low-frequency EM to a high-frequency stage and eventually to CM [ 4 ]. CM is defined as a headache on ≥15 days per month for ≥3 months, of which ≥8 days meets the criteria for migraine with or without aura or responds to migraine-specific treatment [ 5 ].…”

OnabotulinumtoxinA for chronic migraine: a critical appraisal

“… 5 This does not happen suddenly, but is a gradual process, initially changing from low-frequency EM to a high-frequency stage and eventually to CM. 6 CM is defined as a headache on ≥15 days per month for ≥3 months, of which ≥8 days meet the criteria for migraine with or without aura or responds to migraine-specific treatment. 7 Approximately 88% of CM sufferers will seek help from a health professional; however, the majority of patients are underdiagnosed.…”