“Transforming migraine” is not a medical term. However, “transformed migraine” is a term that doctors used in the past. “Transformed migraine” described migraine episodes that had gone from being occasional to frequent.
Today, doctors call this process the “chronification” of migraine. When a person experiences headaches for a minimum of 15 days out of every month and has symptoms that resemble a migraine episode on at least 8 of those days, they have chronic migraine.
In the United States, chronic migraine affects 3–5% of the general population. It is
Keep reading to learn more about transformed or chronic migraine and its symptoms, diagnosis, and treatment.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
The concept of migraine transformation originated in the
Transformed migraine is now an outdated term. Instead, doctors refer to this process as the chronification or progression of migraine.
Anyone who has experienced headaches for 15 or more days per month for at least 3 months, and headaches with features of migraine on at least 8 of those days, has chronic migraine. Doctors no longer use a separate term for people who initially had episodic migraine.
A person with migraine chronification will notice that their symptoms become increasingly frequent. This may happen fairly quickly or over a longer period, taking
The symptoms of migraine include:
Some people also experience auras shortly before the pain begins. Auras are sensory disturbances, such as seeing spots or flashes of light, temporary vision loss, or strange sensations on the skin.
Episodic migraine is when a person has episodes on
- go into remission
- stay the same
- progress to the chronic type
A 2019 study suggests that approximately
According to the
- Increased cortical hyperexcitability: This is when the cortex, or the outer layer of the main part of the brain, has an imbalance of electrical activity.
- Central trigeminothalamic sensitization: This refers to increased sensitivity of the trigeminal nerve, which is one of the major nerves in the face. The trigeminothalamic tract carries sensory information to the brain, such as touch, pain, or temperature signals.
- Defective descending pain modulatory activity: This is abnormal activity in regions of the brain that integrate sensory input and the behavioral response to pain.
Although researchers are still learning about the physiological changes that lead to chronification, they have identified a few risk factors. They split these into modifiable and nonmodifiable.
Modifiable risk factors
Modifiable risk factors are things people can change. These
- high caffeine consumption
- low sleep quality
- sleep disorders, such as sleep apnea
- ineffective treatment for episodic migraine
- medication overuse, which can result in rebound headaches
Nonmodifiable risk factors
Nonmodifiable risk factors are things a person cannot change,
- Sex: Females are
more likelyto have chronic migraine than males, especially during puberty and menopause. Scientists believe this may be due to fluctuating estrogen levels. Research into this connection is ongoing.
- Age: The prevalence of chronic migraine among people with the condition peaks between the ages of 18–29 and again between 40–49.
- Race: Migraine is generally more common among white people than other groups, but this is especially true for chronic migraine. The reasons for this are unknown.
- Education level: Many studies on chronic migraine have found that the condition is more common among people with a lower education level. This may point to health inequity having an impact on rates of chronic migraine, although how education might impact the progression from episodic to chronic is unclear.
- Cutaneous allodynia: This condition occurs in around 63% of people with migraine and causes a person to feel pain in response to non-noxious stimuli. Scientists believe it may be an indicator of a hypersensitive nervous system.
- Genetics: There are few studies linking genetic differences to chronic migraine specifically, but one theory is that some mutations in the COMT gene may play a role. More studies are necessary to prove this.
Another factor is co-occurring illnesses. Some conditions that may raise the risk for chronic migraine include:
- head and neck injuries
- psychiatric conditions, such as severe depression and anxiety
- cardiovascular disease, such as heart disease and stroke
- metabolic syndrome, a cluster of conditions that increase the risk of heart disease, such as high blood pressure, abdominal obesity, and high blood sugar
- pain syndromes, such as back pain and fibromyalgia
There is no single test for chronic migraine, so doctors have to use other information to determine if the symptoms meet the criteria for migraine and not another headache disorder. This
- taking a detailed medical history
- tracking the frequency and pattern of symptoms
- ruling out other diagnoses
For a chronic migraine diagnosis, the symptoms must be consistent with typical migraine symptoms and occur on enough days out of every month to qualify.
If the headaches have become increasingly frequent and have links to a preexisting headache disorder, it may be that episodic migraine attacks have become chronic. However, if the headache is brand new and occurs every day, the symptoms may be more consistent with new daily persistent headache, which is a distinct disorder.
Treatment for chronic migraine differs from the treatment of episodic migraine. For occasional migraine episodes, people can take medications after the onset of the headache to reduce pain, such as over-the-counter pain medications or triptans.
In chronic migraine, doctors can prescribe both acute medications to treat pain and other medications to reduce migraine frequency. These may include:
- calcitonin gene-related peptide
- tricyclic antidepressants
- serotonin agonists
- onabotulinumtoxin A (Botox), which has a neuromuscular-blocking effect that reduces headache days by 50%
- anti-CORP monoclonal antibodies, such as eptinezumab (Vyepti)
A range of lifestyle adjustments and complementary therapies may also help, including:
- identifying and avoiding triggers
- maintaining a consistent sleep-wake schedule
- avoiding caffeine
- having acupuncture or acupressure
- biofeedback therapy, which involves the electronic monitoring of involuntary body functions to train a person to get voluntary control over them
In terms of health and life expectancy, chronic migraine is not serious. Although the pain can be intense and highly disruptive, the condition does not cause permanent damage or shorten a person’s life in the vast majority of cases.
The most serious outcome for most people with chronic migraine is the impact the symptoms can have on their overall well-being and ability to function. Migraine is a leading cause of disability and can affect a person’s career, relationships, and mental health.
People with recurring headaches or who have noticed their episodic migraine symptoms are becoming more frequent should speak with a doctor. A plan to manage the condition can greatly improve quality of life.
“Transformed migraine” is an outdated term for episodic migraine that has become chronic. This is fairly uncommon — approximately
Doctors base the diagnosis on the symptoms, the pattern in which they occur, and a person’s medical history. Treatment involves minimizing pain while also avoiding medication overuse. A person may benefit from a combination of drug and nondrug treatments, such as triptans combined with lifestyle changes.
Speak with a doctor if migraine episodes are becoming more frequent, even if this process has taken a long time. More effective treatments and management strategies may be available.