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Article about Migraines

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THIS IS ONLY Page 1 of the article. Use the link to see the entire thing... (may require registration w/ medscape, which is free)

Nina :rolleyes:


From Headache

The Journal of Head and Face Pain

Understanding the Patient With Migraine: The Evolution From Episodic Headache to Chronic Neurologic Disease. A Proposed Classification of Patients With Headache

Posted 06/07/2004

Roger K. Cady, MD; Curtis P. Schreiber, MD; Kathleen U. Farmer, PsyD

Abstract and Introduction


Traditionally, episodic primary headache disorders are characterized by a return of preheadache (normal) neurologic function between episodes of headache. In contrast, patients with chronic headache often do not return to normal neurologic function between headache attacks. This article proposes that the evolution from episodic migraine to chronic headache may parallel the neurologic disruption observed during the progression of an acute migraine attack and that changes in baseline neurologic function between episodes of headache may be a more sensitive indicator of headache transformation than headache frequency alone. Early recognition of nonheadache changes in nervous system function may offer a more sensitive and specific approach to migraine prevention.


Migraine affects at least 12% of the adult population in the United States.[1,2] For most, migraine is an episodic disorder. These episodes vary considerably in frequency and severity among individuals, among different attacks in the same individual, and even during different periods of a migraineur's life. Migraine attacks typically produce headaches of moderate to severe intensity, and, if unsuccessfully treated, commonly result in significant interruption of daily functions. The burden of living with migraine is significant. It is estimated that migraine accounts for over 110 million lost workdays per year,[3] and it has a substantial impact on workplace and home productivity. In fact, the greatest burden of migraine to society results from lost productivity.[4]

Despite the significant disability imposed by episodic migraine, most people self-manage attacks throughout their lives. Multiple factors account for this, such as perceived cultural norms; that migraineurs generally return to normal function relatively quickly; and, at least in the United States, the prolific promotion of over-the-counter headache remedies. For many migraineurs, however, migraine is not successfully self-managed, and it becomes a chronic condition that requires ongoing medical care through decades of life. Determinants of when a person makes the decision to seek medical care for migraine are largely dependent on headache frequency and symptomatology that patients experience between their attacks of headache (R.K.C., unpublished data, 2003).

The time periods between most attacks of migraine are characterized by normal neurologic function. For approximately 20% of the International Headache Society (IHS)-defined migraine population, however, this episodic pattern of migraine evolves into a chronic headache disorder where normal neurologic function no longer occurs between episodes of migraine.[5-7] This transition delineates the episodic migraine syndrome from the disease state of chronic daily headache and suggests that, at least for some portion of the migraine population, migraine may be a progressive neurologic disease.

Decline of normal neurologic function between episodes of migraine is frequently characterized by psychological conditions, chronic nonspecific headache, gastrointestinal disorders, and muscle pain syndromes. In addition, a subset of patients appear to overuse acute headache medications and develop pharmacologically maintained or medication overuse headache patterns. Although clinical studies have characterized these different populations of those affected by chronic headache, longitudinal studies have not been undertaken to fully understand the epidemiology and natural history of chronic headache disorders.

Section 1 of 9

Next Page: Understanding the Event of Migraine

Roger K. Cady, MD, Curtis P. Schreiber, MD, Kathleen U. Farmer, PsyD, Headache Care Center and Primary Care Network, Springfield, Mo

Headache 44(5):426-435, 2004. ? 2004 Blackwell Publishing

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That was an excellant article. I've been wondering if my headaches were migrains, but after reading that, I don't believe they are. I certainly have the GI discomforts and the muscle pains that the subset of migrainours have between episodes.

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