Chronification of migraine: what clinical strategies to combat it?

Abstract

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 C4 days a month for C3 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 present.

Treatment of Chronic Migraine with OnabotulinumtoxinA: Mode of Action, Efficacy and Safety

“…Risk factors for chronification include young age at onset, frequent migraine attacks at baseline, mood disturbances (e.g., depression), as well as the presence of cutaneous allodynia [ 38 ]. To reduce the risk of migraine chronification, proper prophylactic anti-migraine drugs in appropriate doses should be used, and attention should also be paid to concomitant factors such as depression, hypertension and obesity [ 84 ]. When the episodic state of migraine is transformed to chronic state, treatment options become very limited.…”

Consensus formalisé: recommandations de pratiques cliniques pour la prise en charge de la migraine du patient adulte africain

“…En cas de contre-indication, d'intolérance ou d'inefficacité, le choix de la molécule repose sur le terrain, les comorbidités et la sévérité de la migraine en considérant toujours la balance bénéfice/risque (poids, sédation, asthénie et risque tératogène) et l'existence d'une AMM [27, 37]. Quelques situations cliniques permettent d'orienter le choix de la molécule à utiliser [38–40]: tendance à la prise de poids: éviter l'amitriptyline, le pizotifène et le valproate de sodium, et préconiser le topiramate; syndrome de raynaud, asthme, troubles sexuels, pratique du sport: éviter les bétabloquants; tendance à la constipation: éviter l'amitriptyline; tendance dépressive, troubles du sommeil, céphalées de tension associées: préférer l'amitriptyline; hypertension artérielle associée, stress: privilégier les bétabloquants; migraine avec aura: éviter les bétabloquants et privilégier les antiépileptiques.…”

“…En cas d’échec (réduction des crises < 50%), une association à dose minimale efficace est envisageable, en évitant la même classe thérapeutique et l'association d'un triptan à un autre vasoconstricteur. Il est recommandé de débuter le traitement prophylactique par une monothérapie à faible dose [28, 37, 38]. La posologie peut ensuite être augmentée de façon progressive pour atteindre un effet optimal.…”

Region-specific disruption of the blood-brain barrier following repeated inflammatory dural stimulation in a rat model of chronic trigeminal allodynia

“…This repeated dural stimulation, representing the repeated episodic nature of migraine attacks, produces an acute phase of trigeminal allodynia in the rats. After receiving five or more infusions, baseline morning trigeminal sensitivity develops, representing a transition from an episodic to a chronic state of trigeminal sensitivity, which is similar to patients who transition from episodic to chronic migraine (32). After 10 infusions, they completely transition to a state of chronic trigeminal sensitivity that is maintained, outlasting the final infusion by upwards of three months; at this stage, they are considered transitioned rats.…”