Chronic migraine : what, who, how

Chronic migraine : what, who, how

As you will see in this article, chronic migraine is more complex to manage than episodic migraine.

🧐 What is chronic migraine?

Chronic migraine is a subcategory of migraine, defined by 15 or more headache days per month for over 3 months, with at least 8 days per month of migraine for over 3 months, with or without aura.

The management of chronic migraine involves four steps:

  • The first step to finding an appropriate treatment for chronic migraine is to establish a correct diagnosis, which requires good communication and preparation for consultations with your doctor.
  • The second step is to minimize or eliminate the triggers for daily migraine attacks in the patient’s life. This requires identifying these triggers effectively.
  • The third step is to monitor medication use to avoid the risk of medication overuse headache. When used correctly and at a low frequency, medications can reduce migraine symptoms. However, overuse of certain medications can worsen the frequency, severity, and duration of migraine attacks.
  • The fourth and final step is ongoing management of migraine. Keeping a record of all migraine attacks in the Apo application helps determine if the condition is improving or if action is needed.

Chronic migraine is more challenging to manage than episodic migraine. Patients experience a greater daily impact, including more frequent migraine attacks, more migraine-related issues such as back or neck pain, and, most importantly, fewer migraine-free days each month.

Chronic migraine has a dual impact:

  • On an individual level: The patient’s quality of life is significantly reduced.
  • On a societal and economic level: There is a substantial cost involved, both in terms of direct costs related to medications and medical consultations and indirect costs due to decreased productivity.

💊 What is Medication Overuse Headache?

Medication overuse headache (MOH) is a type of headache that occurs on at least 15 days a month and is a result of overusing headache medications for over 3 months. Medication overuse is defined as the regular use of pain relievers (such as paracetamol or anti-inflammatories) for at least 15 days a month or the regular use of triptans, combination analgesics, ergotamines, opioids, or any combination of these medication classes for at least 10 days a month.

Medication overuse is often associated with a high frequency of headaches and can be a consequence or trigger for chronic migraine. Therefore, it’s crucial to monitor medication use to avoid the risk of medication overuse headaches.

To effectively track your medication usage, remember to update the “My Treatments” section in your profile, especially after a consultation and any changes to your prescription.

🔴 What is severe migraine?

Severe migraine can be diagnosed when a patient experiences at least 8 days of migraine per month, or less than 8 days of migraine per month but meets at least one of the following criteria:

  • A score of 60 or higher on the HIT-6 questionnaire, which measures the impact of headaches on the patient’s daily life.
  • Complete interruption of activity due to at least 50% of headache episodes.

The level of disability depends on the frequency and intensity of the headaches.

😞 How does chronic migraine impact the patient’s daily life?

Chronic migraine can have a significant impact on a patient’s quality of life, both on a personal and societal level. It can hinder the patient’s ability to work, pursue professional or personal projects, and engage in social activities. A study conducted in the United States in 2008 on 520 patients with chronic migraine found that nearly 65% of those with chronic migraine reported that their work had been negatively affected by their migraine symptoms. Additionally, patients with chronic migraine tend to miss more days of work and have lower productivity due to headaches compared to those with episodic migraine.

Patients with chronic migraine may also experience other neurological disorders and pain conditions in addition to their migraine symptoms. For example, lower back pain, arthritis, and joint pain are more common among patients with chronic migraine. These are known as comorbidities, which involve the presence of multiple chronic conditions in the same individual, each of which may require long-term care.

👩‍⚕️ How is chronic migraine diagnosed?

Patients with headache disorders need to be diagnosed as having either episodic or chronic migraine. According to a study conducted in the United States in 2008 by Dr. Richard B. Lipton, Dr. Michael L. Reed, and Dr. Marcelo Bigal, involving 520 patients, only 20% of those who met the criteria for chronic migraine received an accurate diagnosis. Part of this percentage might be attributed to the difficulty some patients have in answering questions about their migraine. Patients tend to recall only the severe migraines and may forget to mention days when migraine affects their daily life with mild headaches, symptoms, and other impacts. Assessing the frequency and potential medication overuse could help with the diagnosis of chronic migraine. A study conducted in the United States in 2011 suggested that the key question for diagnosing chronic migraine should be, “How many days in a month were you without a migraine?”

It is essential to keep track of your migraine attacks and all the associated symptoms for better monitoring and management of your migraine. With Apo Migraine, you can record your migraine attacks in less than 30 seconds, monitor the progression of your condition, and assess the impact of your attacks on your daily life. Input the necessary information about your migraine, such as triggers, symptoms, medication usage, and the severity and impact of your attacks. This way, you can gain an overview of your migraine. Share the comprehensive medical report generated by the application with your doctor, either via email or by printing it out for your consultation. This report analyzes all your recorded attacks, providing your doctor with valuable insights into your migraine and medication consumption, making it easier to establish an accurate diagnosis.

If you’re not familiar with the medical report or haven’t shared it with your doctor in previous consultations, you can watch a video featuring Céline, the creator of Apo and a migraine sufferer, sharing her experience.

As mentioned in the introduction of the article, merely knowing the number of days with migraine is insufficient. Your doctor also needs data on the impact of your migraine on your daily life to accurately diagnose chronic or severe migraine and offer the appropriate treatment. This is why you can assess the impact of your migraine on your daily life quarterly through the Apo application. You can find this in the “Migraine Assessments” section on the home screen (if this section is not on your home screen, you need to update your application).

With Apo, you can complete two scientifically validated questionnaires specifically for migraine: HIT-6 and HAD. HIT-6 helps you describe and express what you experience and what you can’t do due to your headaches, while HAD assesses the emotional impact of your migraine. After completing these questionnaires, you can track the evolution of your scores in the Calendar and Statistics section. These scores will also be added to the medical report to be sent to or discussed with your doctor during your consultation. This way, your doctor will have all the necessary information (number of days with migraine, impact, medication usage, etc.) to make the most accurate diagnosis and suggest the treatment plan with the best chance of success.

If you’re not familiar with the impact scales or haven’t had a chance to respond to them in the APO app, you can explore this feature through this short video tutorial.

🎯 How is chronic migraine treated?

Once the diagnosis is established, a therapeutic approach is determined. This approach aims to address various aspects of migraine. It takes into account factors such as the assessment and treatment of mood disorders, stress reduction, and the alleviation of migraine-related pain. Throughout this treatment, the patient must maintain good sleep hygiene and avoid identified triggers.

For more information, we invite you to read our articles on migraine and sleep, as well as meditation and migraine. They can help you naturally reduce the impact of your migraine on your daily life.

In recent years, there have been significant developments in new migraine treatments, including Botox and anti-CGRP medications. These treatments offer hope for chronic migraine patients.

An American study conducted in 2013 by the Allergan laboratory suggests that botulinum toxin (Botox) is a treatment specifically designed for preventing headaches in adults with chronic migraine. Botulinum toxin gradually relaxes the muscles, which provides relief from migraines, according to the study.

This treatment reduces various dimensions of migraine, including symptoms, headache frequency, and intensity. Typically, three injections of the treatment are required to assess its effectiveness. Patients who continue the treatment often experience a reduction in symptoms after receiving five injections.

On the other hand, anti-CGRP medications are part of a new generation of drugs known as monoclonal antibodies. During a migraine attack, a substance called CGRP (calcitonin gene-related peptide) is released in the brain, and this protein is responsible for pain. CGRP promotes blood vessel dilation and inflammation. Anti-CGRP drugs recognize this molecule and neutralize its effects.

People who have failed to respond to other therapies and experience 8 or more days of migraine per month are eligible for this treatment. It typically involves a monthly injection, either subcutaneously or intravenously.

👉 In conclusion, chronic migraine is a complex condition that requires a true collaboration between the patient and the doctor to overcome it.

The treatment of chronic migraine involves a proper diagnosis, which depends on good communication and a thorough consideration of the patient’s triggers and symptoms. It is essential to record your migraine attacks with the necessary information and evaluate the long-term impact of your migraine to establish a correct diagnosis of chronic or severe migraine and offer you the appropriate treatment. Apo is here to assist you with that.

As we have seen in this article, chronic migraine is more challenging to manage than episodic migraine. According to the SFEMC, 3% of episodic migraineurs unfortunately develop chronic migraine each year.

The Apo Team is considering the possibility of offering a slightly different version of the Apo application, potentially with daily information input for chronic migraine sufferers or for episodic migraine sufferers experiencing a deterioration in their condition, to help them closely monitor their migraine and gradually take control of it.