Fast Five Quiz: Overview of Chronic Migraine

Jasvinder Chawla, MD, MBA


February 22, 2022

The choice of laboratory and/or imaging studies is determined by individual patient presentation.

High peripheral blood levels of calcitonin gene-related peptide, a neurotransmitter that causes vasodilation, can aid in the diagnosis of chronic migraine by serving as a biomarker for permanent trigeminovascular activation. In a 2013 study by Cernuda-Morollón and colleagues, patients with migraine had a calcitonin gene-related peptide level of 74.90 pg/mL, significantly higher than that in the other participants. Blood samples in the study were obtained between, rather than during, migraine attacks. In addition, patients with chronic migraine with a history of aura had significantly higher calcitonin gene-related peptide levels than did patients with chronic migraine who had never experienced an aura.

In a study by Nguyen and colleagues, quantitative sensory testing, including stimulus amplitude discrimination, temporal order judgment, and duration discrimination, found significant differences in the perception of vibrotactile stimulation in patients with migraine compared with control participants. This measurement of headache-pain severity could help to improve the diagnosis of migraine and enable more accurate assessments of treatment efficacy.

As part of the American Headache Society's list of five commonly performed tests or procedures that are not always necessary in the treatment of migraine and headache (as part of the American Board of Internal Medicine Foundation's Choosing Wisely campaign), neuroimaging studies in patients with stable headaches that meet the criteria for migraine are not warranted.

Visual field testing should typically be performed only in patients with persistent visual phenomena.

Learn more about the diagnosis of chronic migraine.


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