Fast Five Quiz: Overview of Chronic Migraine

Jasvinder Chawla, MD, MBA; Heidi Moawad, MD


June 27, 2023

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 anatomic changes during the progression of a migraine attack or the transformation of episodic to chronic migraine. Previous studies have identified structural and functional alterations in some brain regions of patients with chronic migraine, indicating that maladaptation of the top-down pain modulation, followed by sensitization of the trigeminal system, is 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, wherein 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 believed to be a vascular phenomenon resulting from intracranial vasoconstriction, followed by rebound vasodilation. Currently, however, the neurovascular theory predominates; it describes 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 70% of migraineurs have a first-degree relative with a history of migraine. The risk is increased fourfold in relatives of people who have migraine with aura.

Learn more about the pathophysiology of migraine.


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