Fast Five Quiz: Overview of Chronic Migraine

Jasvinder Chawla, MD, MBA

Disclosures

February 22, 2022

The pathophysiology of chronic migraine is poorly understood, even though several risk factors have been associated with migraine progression. However, considerable progress has been made in elucidating the pathophysiologic mechanisms of migraine, associated genetic factors that may influence susceptibility to the disease, and functional and anatomical changes during the progression of a migraine attack or the transformation of episodic to chronic migraine. Recent studies have identified both structural and functional alterations in some brain regions of patients with chronic migraine indicating that maladaptation of the top-down pain modulation and subsequent sensitization of the trigeminal system may be important in the pathogenesis of chronic migraine.

According to Andreou and Edvinsson, migraine is a lifespan neurologic disorder that follows an evolutive age-dependent change in its prevalence and even clinical presentations, whose attacks evolve over different phases with specific neural mechanisms and symptoms during each phase. As a result, in some patients, migraine can be transformed into a chronic form with daily or almost-daily headaches.

Migraine was previously considered to be a vascular phenomenon that resulted from intracranial vasoconstriction followed by rebound vasodilation. Currently, however, the neurovascular theory describes episodic migraine as primarily a neurogenic process with secondary changes in cerebral perfusion associated with a sterile neurogenic inflammation.

Migraine, as a primary headache, has a strong genetic component. Approximately 64% of migraine patients have a first-degree relative with a history of migraine. The risk for migraine is increased fourfold in relatives of people who have migraine with aura.

Learn more about the pathophysiology of migraine.

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