Transformed migraine has a serious impact on people’s quality of life and day by day activities. Patients usually tend to suffer from depression and anxiety.
Transformed migraine is what it is understood today as chronic migraine. Refers to the presence of tension-type headache for 15 days or more per 30 days in a patient with a history of episodic migraine for at the least 3 months.
This is essentially the most common type of chronic day by day headache.
Patients have a history of episodic migraines that begin within the second or third decade of life. Progress is generally gradual, but violence has been reported in 15-30% of people.
Treatment is complex and may deal with pain prevention in addition to lifestyle changes. The transformation of episodic migraine is related to the abuse of analgesics and ought to be considered in management.
How is chronic or transformed migraine defined?
concept transformed migraine comes from the evolution from episodic (less common) to chronic migraine. Overall, the condition loses a few of the features of migraine, resembling tension headaches. Episodes are more frequent but less intense.
According to the International Headache Society and its criteria published in 2006, the diagnosis of transformed migraine requires:
- 15 days or more of headaches (tension or migraine) per 30 days for at the least 3 months.
- 8 or more days of headache per 30 days for 3 months with 2 of the next 4 characteristics: unilateral location, throbbing, moderate to severe, aggravated by exercise; and with 1 of the accompanying symptoms (nausea, photophobia, phonophobia). Or when treated with ergotamine or triptans, it prevents migraine symptoms from developing.
- 5 or more previous episodic migraine attacks (normally without aura).
- Not related to overuse of painkillers or other causes.
Symptoms
Since it is taken into account a chronic episodic migraine, the symptoms are the identical:
- Unilateral throbbing headache
- Sensitivity to light or sound (photophobia and phonophobia)
- Nausea and vomiting
The presence of an aura before the onset of pain will not be as common in these cases.
Sometimes, could also be indistinguishable from tension headaches. Thus, the coexistence of migraine and tension features led to the hypothesis of a relationship that features them within the concept mixed headache Or migraine-tension headache syndrome.
Over time, headaches are likely to worsen in frequency, but lessen. Until it will definitely develops right into a chronic, day by day or near-daily headache, with overlapping characteristics of a tension headache and a classic migraine.
It is commonly related to overuse of painkillers, sleep disturbances, depression and anxiety. This is why it’s believed that this may increasingly be influenced by stress, the presence of traumatic aspects or the consumption of tobacco and alcohol to chronic episodic migraine.
Read more: Migraine causes, symptoms, diagnosis and treatment
Risk aspects
Risk aspects for developing transformed migraine include:
- Stress
- female
- Genetic tendency
- Caffeine consumption
- Poor sleep hygiene
- History of episodic migraine
- Hormonal changes related to menopause
- Mental disorders comparable to anxiety or depression
- Overuse of painkillers within the treatment of acute headache attacks
Among them, the last factor is of particular importance. Overuse of painkillers is defined as taking these drugs for 15 days or more in a month, for non-opioid painkillers or 10 or more days per 30 days for triptans, ergotamines, opioids and combination painkillers.
To properly classify transformed migraine, reliever analgesics ought to be discontinued for two months.
Treatment of transformed migraine is complex
Treatment of transformed migraine requires preventive treatment, lifestyle changes and elimination of triggers. However, its effectiveness will not be immediate and will be delayed as much as 3-6 weeks from its initiation.
Rescue medications, including non-opioid analgesics comparable to ergotamine and triptans, mustn’t be prescribed. The preventive approach involves using the next drugs:
- Tricyclic antidepressants (nortriptyline) or selective serotonin reuptake inhibitors (fluoxetine), which also relieve depression, anxiety and related sleep disorders.
- Beta-blockers (atenolol, metoprolol and propanolol).
- Anticonvulsants (topiramate and valproic acid). Contraindicated in women of childbearing age.
- Injection of botulinum toxin (especially useful for individuals who cannot tolerate day by day oral medications).
- Monoclonal peptide antibodies related to the calcitonin gene comparable to erenumab, fremezumab, galcanezumab and eptinezumab.
In general, a mix of medicine with different mechanisms of motion is required to regulate symptoms. Antidepressants are sometimes combined with beta-blockersFor example.
Non-steroidal anti-inflammatory drugs, triptans and ergotamines are really helpful for the treatment of acute episodes of pain in individuals who should not abusing analgesics. In addition, habit adjuvants comparable to regulating sleep schedules, avoiding known triggers, and adhering to meal times ought to be considered.
Cognitive therapies (leisure, coping with stress) have some effectiveness. Dietary measures are also really helpful comparable to stopping using caffeine in addition to smoking.
Learn more: What is an ophthalmoplegic migraine?
Transformed migraine could be disabling
As a day by day or near-daily headache, it affects quality of life and mood. Therefore, along with the impact on on a regular basis life, it exposes you to the abuse of medicine that relieve painful attacks.
Therefore, the prescribed medicine ought to be limited and mustn’t be used greater than a few times per week. In addition, individuals with transformed migraine fairly often experience psychiatric disorders for which psychotherapy could be helpful.
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