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Chronic Migraine: Transformation and Reversion Factors

Guest Editor: Todd J. Schwedt, MD

Chronic Migraine: Transformation and Reversion Factors
Todd J. Schwedt, MD

Chronic migraine is defined by the International Classification of Headache Disorders as a migraine pattern in which there are at least 15 days per month with headache, including 8 days per month on which there are full-blown migraine attacks and/or attacks successfully treated with triptans or ergots prior to expression of full-blown migraine symptoms. Two to three percent of the general population has chronic migraine. Chronic migraine exerts substantial impact on patients; impact that is felt physically, emotionally, professionally, and socially. Furthermore, chronic migraine is costly to society due to direct medical expenses (e.g. doctor visits, medications) and indirect medical expenses (e.g. lost productivity).

Patients with chronic migraine typically transition from episodic migraine (less than 15 headache days/month) to chronic migraine and often eventually revert from chronic migraine back to episodic migraine. Identification and study of risk factors for the transformation to chronic migraine and for the reversion to episodic migraine could lead to important advancements for the diagnosis and treatment of migraine. This virtual issue consists of manuscripts published within Headache and other American Headache Society assets (podcast, video, handouts, patient education pages) that address the transformation to and reversion from chronic migraine.


Concepts and Mechanisms of Migraine Chronification
Bigal ME, Lipton RB
Headache 2008;48;1:7-15.

From Migraine To Chronic Daily Headache: The Biological Basis of Headache Transformation
Meng ID, Cao L
Headache 2007;47;8:1251-1258

How Pain, Including Headache, Becomes Chronic
Dodick DW.
Headache 2007;47;8:1272-1274.

Is migraine a progressive disorder?
Bigal ME
American Headache Society – Information for Health Care Professionals

Risk Factors 

Risk Factors for Headache Chronification
Scher AI, Midgette L, Lipton RB
Headache 2008;48;1: 16-25.

From transformed migraine to episodic migraine: reversions factors
Seok J, Cho H, Chung C.
Headache 2006;46:1186-1190.

Modifiable risk factors for migraine progression
Bigal ME, Lipton RB
Headache 2006;46:1334-1343.

Migraine: Epidemiology, impact, and risk factors for progression
Lipton RB, Bigal ME
Headache 2005;45(Suppl. 1):S3-S13.

Transformed or evolutive migraine
Mathew NT, Reuveni U, Perez F
Headache 1987;27:102-106.

Transformation of episodic migraine into daily headache: Analysis of factors
Mathew NT, Stubits E, Nigam MP
Headache 1982;22:66-68.

Risk Factors - Genetic 

Frequency of Headaches in Children is Influenced by Headache Status in the Mother
Arruda MA, Guidetti V, Galli F, Albuquerque RC, Bigal ME
Headache 2010;50;6:973-980.

Family History for Chronic Headache and Drug Overuse as a Risk Factor for Headache Chronification
Cevoli S, Sancisi E, Grimaldi D, Pierangeli G, Zanigni S, Nicodemo M, Cortelli P, Montagna P
Headache 2009;49;3:412-418. 

No Influence of 5-HTTLPR Gene Polymorphism on Migraine Symptomatology, Comorbid Depression, and Chronification
Thomas Wieser, Kathrin Dresler, Stefan Evers, Charly Gaul, Dorothea König, Daniela Hölzl, Klaus Berger, Dale Nyholt and Thomas Deufel
Headache 2010;50;3:420-430

Risk Factors - Medication Overuse

Acute Migraine Medications and Evolution From Episodic to Chronic Migraine: A Longitudinal Population-Based Study
Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB
Headache 2008;48;8:1157-1168.

Screening And Behavioral Management: Medication Overuse Headache – The Complex Case
Lake AE
Headache 2008;48;issue 1: 26-31.

Does chronic daily headache arise de novo in association with regular use of analgesics?
Bahra A, Walsh M, Menon S, Goadsby PJ
Headache 2003;43:179-190.

Medication Overuse Headache
Silberstein SD
American Headache Society – Information for Health Care Professionals

Brainstorm – Medication Overuse
Silberstein SD, Loder E, Dodick D, Litin S.
American Headache Society video

Risk Factors - Sleep

Chronic Headache and Potentially Modifiable Risk Factors: Screening and Behavioral Management of Sleep Disorders
Rains JC
Headache 2008;48;1: 32-39.

Behavioral sleep modification may revert transformed migraine to episodic migraine
Calhoun AH, Ford S.
Headache 2007;47:1178-1183. 

Risk Factors - Psychological

Childhood Maltreatment and Migraine (Part II). Emotional Abuse as a Risk Factor for Headache Chronification
Tietjen GE
Headache 2010;50;1:32-41.

The stress and migraine interaction
Sauro KM, Becker WJ
Headache 2009;49:1378-1386.

Stress and Headache Chronification
Houle T, Nash J
Headache 2008;48;1:40-44.

Headache Chronification: Screening and Behavioral Management of Comorbid Depressive and Anxiety Disorders
Smitherman TA, Maizels M, Penzien DB
Headache 2008;48;1:48-50.

The association of frequent headaches with personality and life events
Passchier J, Schouten J, van der DJ, Van Romunde LK
Headache 1991;31(2):116-121.

Risk Factors - Menstrual Migraine

Elimination of menstrual-related migraine beneficially impacts chronification and medication overuse
Calhoun A, Ford S
Headache 2008;48:1186-1193.

Risk Factors - Obesity

Migraine and obesity: epidemiology, mechanisms, and implications
Peterlin BL, Rapoport AM, Kurth T.
Headache 2010;50:631-648.

Migraine and obesity: epidemiology, mechanisms, and implications.
Peterlin BL.
Podcasts for Health Professionals – Headache online.

Research Design and Data Analysis

Looking to the Future: Research Designs for Study of Headache Disease Progression
Lipton RB, Bigal ME
Headache 2008;48;1:58-66.

Rethinking Headache Chronification
Dana P. Turner, Todd A. Smitherman, Donald B. Penzien, Richard B. Lipton and Timothy T. Houle
Headache 2013;53;6:901-907

Rounding Behavior in the Reporting of Headache Frequency Complicates Headache Chronification Research
Timothy T. Houle, Dana P. Turner, Thomas A. Houle, Todd A. Smitherman, Vincent Martin, Donald B. Penzien and Richard B. Lipton
Headache 2013;53;6:908-919

Influence of Random Measurement Error on Estimated Rates of Headache Chronification and Remission
Timothy T. Houle, Dana P. Turner, Todd A. Smitherman, Donald B. Penzien and Richard B. Lipton
Headache 2013;53;6:920-929

Methodological Issues in Studying Rates and Predictors of Migraine Progression and Remission
Richard B. Lipton, Donald B. Penzien, Dana P. Turner, Todd A Smitherman and Timothy T. Houle
Headache 2013;53;6:930-934

Patient Education Pages

Migraine “Chronification”: What You Can Do
Rothrock JF
Headache 2009;49;1:155-156.

Migraine “Chronification”
Rothrock JF
Headache 2008;48;1: 181-182.

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Updated August 2013

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