Natural Migraine Relief | Migraine Treatment

Few conditions are more disabling than chronic migraine.

Thankfully, the past 20 years have seen great progress in effective treatment of acute migraine. Unfortunately, those treatments don't work for everyone or for every type of headache.

Also, there remains a need for better preventive medications.

Banjo can be used to treat acute migraine. Or it can be taken daily to reduce the frequency and severity of migraine attacks.

Banjo may also be useful in treating migraine or chronic headache that occurs with fibromyalgia, Sjogren's, lupus, MS and other chronic conditions.

Headache & Migraine Notes

The global impact of migraine – research facts

Migraine Facts from Published Research

global impact of migraine

Migraine Incidence and Demographics

  • Migraine is a disease affecting approximately 30 million Americans, equivalent to roughly 13% of the adult U.S. population, or one migraine sufferer in every four U.S. households.
  • Migraine is much more common among women than men. Migraine affects approximately 18% of women and 6% of men.
  • The prevalence of migraine is widespread during the most productive adult years, between the ages of 25 and 55. The incidence of migraine increases from childhood through adolescence and early adult life. The highest frequency of migraine attacks is observed in 35-45 year-old patients, with the prevalence declining somewhat among older patients.
  • The incidence of migraine has been on the rise in the United States. From 1980 to 1989, the prevalence of migraine increased nearly 60%. From 1989 to 1999, the number of migraine sufferers in the United States increased from 24 million to 28 million.

Migraine Diagnosis and Symptoms

  • A population-based survey was conducted in 1999 to compare results with a methodologically identical study conducted 10 years earlier. Key findings of the American Migraine Study II include the following:
  • Approximately half of migraineurs remain undiagnosed– only 48% of respondents who met the clinical definition of migraine reported ever having had their condition diagnosed by a physician.
  • 80% said their migraine headaches were ‘severe’ or ‘extremely severe,’ with 24% seeking emergency room care as a result of an attack.
  • While sufferers with a physician diagnosis tend to have more severe migraines and report more symptoms versus the undiagnosed, there is a high level of suffering reported by both groups:
  • ­ Throbbing pain (85% diagnosed vs. 85% undiagnosed)
  • ­ Sensitivity to light (89% diagnosed vs. 72% undiagnosed)
  • ­ Nausea (80% diagnosed vs. 66% undiagnosed)

Migraine Impact on Quality of Life

  • Migraine has a negative effect on the quality of life, including physical, emotional and social aspects of daily life such as family, work and social relationships.
  • In the American Migraine Study II, approximately one-third of migraine sufferers reported missing work or school, and between 58% and 76% discontinued their normal household activities or canceled family or social activities.
  • 37% of the diagnosed migraineurs reported 1 to 2 days of activity restriction per episode
  • More than half reported experiencing a 50% or more reduction in work and/or school productivity, and 66% said they experienced a 50% or more reduction in housework productivity.
  • 39% of patients report migraine pain so severe they are driven to their beds, sometimes for days at a time.
  • In another recent study, migraine sufferers and their families in the USA and UK reported very similar effects on their quality of life. Of those with migraine living with a household partner, most report negative effects on their relationships inside and outside of the home:
  • 85% reported substantial reductions in their ability to do household work and chores
  • 45% missed family social and leisure activities
  • 32% avoided making plans for fear of cancellation due to headaches
  • One half believed that, because of their migraine, they were more likely to argue with their partners (50%) and children (52%)
  • Most reported other adverse consequences for their relationships with their partner and children, and at work (52-73%)
  • 36% believed they would be better partners except for their headaches. Partners of those with migraine partly confirmed these findings: 29% felt that arguments were more common because of headaches and 20-60% reported other negative effects on relationships at home.

The Economic Impact of Migraine

  • A recent study in JAMA estimated lost productive time from common pain conditions among U.S. workers costs an estimated $61.2 billion per year. The majority (76.6%) of the lost productive time was from reduced performance while still at work, and not work absence.
  • Based on a random sample of 28,902 working adults in the United States, 13% of the total workforce experienced a loss in productive time during a 2-week period due to a common pain condition.
  • Headache was noted as the most common pain condition resulting in lost productive time, affecting 5.4% of the workforce. Workers who had a headache lost an average of 3.5 hours per week.
  • Migraine is an expensive illness to treat, yet two-thirds of the total financial burden is a result of indirect costs. Individuals with migraine, employers, and insurance companies all have an economic stake in reducing the migraine burden. In a recent study comparing migraine sufferers to those without migraine, migraineurs had higher direct medical costs, primarily due to a greater frequency of physician and emergency department visits. The cost of lost productivity for the migraine group was also higher.
  • Since migraine headaches affect approximately 13% of the population in the United States and the condition is most prevalent during the prime working years (25 to 55 years of age), the cost impact on employers is substantial. Migraine causes absenteeism and lost productivity while on the job (“presenteeism”) that represent an enormous cost burden for employers.
  • One recent study estimated that the annual cost of migraine for a single employer, BankOne (a financial services corporation with 80,000 employees), was at least $21.5 million from migraine-related absenteeism, and an additional $24.4 million from reduced on-the-job productivity due to migraine.
  • On average, each migraine sufferer needs 4 to 6 days of bed rest each year.
  • In total, it is estimated that 157 million workdays are lost annually in the United States because of the pain and associated symptoms of migraine.
  • Migraine costs American employers at least $13 billion a year, with nearly $8 billion due to missed workdays and the remainder due to impaired work function. Patients of both sexes aged 30 to 49 years incur higher indirect costs compared with younger or older employed patients.

Migraine Diagnosis and Treatment

  • Migraine remains one of the most underdiagnosed and undertreated neurological conditions. Many neurology researchers now consider migraine to be a neurovascular disorder, with a pathology involving the cerebral nerves, blood vessels, and inflammation. Currently popular theories propose that migraine-specific triggers promote a type of primary brain dysfunction that causes dilation of meningeal blood vessels, inflammation in the meninges (tissue covering the brain), and activation of the adjacent trigeminal nerves which causes the pain and associated symptoms of migraine.
  • The American Migraine Study, based on the responses of more than 20,000 people, confirmed that despite high rates of headache-related disability, most people with migraine have never been diagnosed by a doctor or treated with prescription medications.
  • In a study of individuals in the United Kingdom and the United States who reported six or more migraine headaches per year, patterns were similar in both countries, with most people treating with over-the-counter (OTC) medications and many choosing not to seek a doctor’s assistance to diagnose:
  • patients with migraine who have never consulted a doctor for their headaches (UK 60%, US 68%);
  • never received a correct medical diagnosis (UK 64%, US 77%);
  • treat only with OTC medication (UK 72%, US 70%).

Migraine Medications – OTC and Rx

  • Over 90% of the migraine sufferers in the United States use OTC medications as a part their migraine treatment arsenal, and nearly 60% use OTCs exclusively. Yet, there has been little innovation in the OTC migraine category for many years. In the past six years, a number of ‘new’ OTC medications to treat migraine have appeared, including Motrin Migraine, Advil Migraine and Excedrin Migraine (the first to be approved, January 1998).
  • In fact, these drugs are not new at all; they are identical to the original analgesic formulation for regular Motrin, Advil and Extra-strength Excedrin. The FDA is allowing these companies to repackage these old formulations with a claim for the temporary relief of mild to moderate migraine. According to these companies’ studies, these medications worked better than placebo to treat migraine. However, most of these studies systematically excluded patients who are severely disabled by migraine, which could account for up to 40% of migraine-sufferers.
  • The most common OTC recommendation request made of pharmacists is for a “headache product” – at the rate of approximately 53,000 times per day in the US. Pharmacists suggest an OTC remedy specifically for “migraine pain” nearly 16,000 times/day.
  • Despite the availability of prescription medications designed specifically to treat migraine, there is a consistent preference among migraine sufferers to treat with OTC medications: 57% of migraine headache sufferers report using only OTC medications for treatment, virtually unchanged from 10 years earlier (59%).
  • Though most migraine sufferers use OTC medications, given the frequency and associated disability of their migraine attacks, current therapy appears unsatisfactory.
  • OTC analgesics are only marginally effective against migraine; in only about 25% of those with moderate to severe headache pain do they exhibit any effect.
  • Unfortunately, the OTC medications that many chronic headache sufferers hope will bring them relief may actually trigger more headaches. These headaches, known as analgesic rebound headaches or medication-overuse headaches, are a result of overusing common pain relief medications.
  • Of the prescription medications used to treat migraine, the triptan family of drugs are the most commonly prescribed. The biggest selling triptan is Imitrex®, which has consistently exceeded $1 billion in annual sales.
  • Triptans are believed to work in part by constricting (narrowing) blood vessels. This effect is thought to relieve migraine pain, which is known to be associated with inflamed (enlarged) vessels in the brain. However, triptans also constrict other arteries, such as the coronary arteries.
  • Narrowing of the coronary arteries can put patients at increased risk for heart attacks, and might account for the fact that unpleasant chest-related symptoms such as pressure and pain frequently occur with all triptans.
  • Some researchers also suggest that pulmonary vasoconstriction is a possible underlying cause of the triptan-related chest symptoms.
  • Unpleasant chest-related symptoms occur with all triptans; up to 41% of patients with migraine who receive sumatriptan experience chest-related symptoms, and these symptoms cause 10% of patients to discontinue triptan use altogether.
  • Two-thirds of migraine sufferers delay or avoid taking their current prescription medication because of concerns about adverse effects. This can result in more intense and longer-lasting headaches, the need to rest and cancel social activities, and suboptimal performance.
  • Almost 8 of 10 migraine sufferers (79%) showed an interest in trying a novel product with similar efficacy but fewer adverse effects than other prescription migraine medications. Among those migraine sufferers who use prescription products, pain relief and speed of onset were considered important by at least 75% of them.
  • Headache specialists have also found that overuse of the prescription headache relief medications (analgesics, barbiturates, ergots, triptans) can also lead to rebound headaches.

Pediatric Migraine

  • The prevalence of migraine is also increasing in children. Migraine occurs in approximately 5-10% of children, and up to 18% of adolescents.
  • The quality of life (QOL) of children with headaches is significantly affected by their health condition. The impact of headaches on QOL is similar to that found for other chronic illness conditions, with impairments in school and emotional functioning being the most prominent The impact on QOL of children with migraine was similar to that of children with arthritis and cancer.
  • No prescription migraine medication has been approved for use in children or adolescents.

Sinus Headaches and Migraine

  • Many “sinus headaches” are likely migraine. In one recent study, researchers interviewed a group of patients with ‘sinus headaches’ regarding their headache symptoms and treatment experiences. 96% of the people interviewed actually described symptoms consistent with a diagnosis of migraine.
  • Other recent research also suggests that migraine and perhaps other headache types are sometimes mistaken for sinus headache. Sinus headache is commonly diagnosed, and patients with headache often cite sinus pain and pressure as a cause of their headaches. Nasal symptoms frequently accompany migraine, and there is a possibility that sinus inflammation can sometimes act as a migraine trigger. Considered in aggregate, the data show that the occurrence of nasal symptoms associated with a headache should neither trigger a diagnosis of sinus disease nor exclude a diagnosis of migraine. It should, in fact, prompt diagnostic consideration of both conditions.

Tension-Headaches and Migraine

  • Migraine may be closely related to other types of headaches as well. Researchers recently noted that the similarities between migraine and ‘tension-type’ headaches suggest a ‘convergence model’ for various primary headache types. Symptoms escalate, beginning with a ‘premonitory period,’ progressing into ‘tension-type’ headache and, if uninterrupted, finally into a full-blown migraine. Other headache types, such as ‘sinus headache’ or ‘temporomandibular headache’, may also be explained by this model.
  • In another study, 32% patients initially clinically classified as having disabling episodic ‘tension-type’ headache were determined after further review to actually have migraine or migrainous headache. Among study participants, 90% of subjects with disabling headache had a migraine-related disorder.

Migraine – International

  • Migraine is a global problem. Differences in diagnosis and clinical practice exist, but the prevalence of migraine in most countries approximates that of the U.S., or about 13% of the adult population.
  • Just as in the U.S., migraine is an important public health problem in other countries and is associated with very substantial costs. The international statistics closely mirror the findings of U.S. researchers.
  • For example, a recent study in the UK found 7.6% of males and 18.3% of females reporting migraines within the previous year.
  • The prevalence of migraine varied with age, rising through early adult life and declining by the early 50s. Attack frequency was typically 1-3 migraines per month, and most migraineurs experienced interference with daily activities in 50% of their attacks.
  • On average, an estimated 5.7 working days were lost per year for every migraineur. These results are consistent with those from surveys in other countries.
  • If these findings are projected to the entire UK population, approximately 5.85 million people aged 16-65 years experience 190,000 migraine attacks every day in the UK and lose 25 million days from work or school each year because of them.

Pediatric migraine

5-10% of school-aged children get migraines.

An estimated 10% of US school-aged children miss an avg. of 2 days/month of school due to migraine.

20% of migraine patients experience their first migraine before age 5.

Girls and boys are equally prone to migraine.

During adolescence, 20-30% of young women may experience migraine, along with 10-20% of young men.

In pediatric migraine, the pain is often on both sides of the head.

Nausea and vomiting frequently accompany the headache.

The child frequently tries to avoid lights, noise and strong odors.

About 65% of children do not experience an aura.

About 20% always have an aura, and 15% sometimes do.

60% of those with pediatric migraine will still be having migraine 30 years later.

Early, effective treatment may lesson the frequency and severity of migraine later in life.

Uncommon Migraine

Complicated, variant or less common forms of migraine

A number of complicated and variant forms of migraine are known. While there is some debate over whether certain entities are actually “migraine” – they are generally classified as such because they often have the same triggers as migraine and, in addition to their unusual features, share many features in common with more typical migraine. Unusual forms of migraine may be especially frightening because they mimic life-threatening emergency situations. While generally ‘benign’ (self-limiting and not caused by another disease or condition,) each requires a thorough medical examination. Emergency medical care should be immediately obtained if there is any doubt concerning the origin of symptoms.

Basilar migraine – also called basilar artery or Bickerstaff migraine

Basilar migraine, also known as basilar artery migraine, is rare but potentially dangerous. Basilar migraine always includes aura and is a subtype of migraine with aura. 86% of those with basilar migraine have a family history of basilar migraine. It was previously thought to occur exclusively in teen-aged girls and young women. It has since been recognized in both sexes and all ages but is most common in adolescent girls. Basilar migraine attacks can alternate with typical migraine attacks.

Basilar artery migraine is believed to be associated with, or increase the risk of, strokes or transient ischemic attack (TIA.) Symptoms frequently observed include partial vision loss, double vision, hearing changes, dizziness, vertigo, severe vomiting, slurred speech, loss of coordination, numbness (on one or both sides of the body), weakness, trouble walking (ataxia) and general confusion. These symptoms are usually brief and generally subside with the onset of the actual headache, but may remain for up to several days after headache pain resolves.

Headache pain is located in the back of the head (the occipital area) and at least 2 of the following symptoms must be observed during the aura stage:

  • Ataxia (a severe loss of coordination – especially trouble walking)
  • Bilateral paresthesias (strange feelings or sensations on both sides of the body)
  • Deafness
  • Decreased consciousness
  • Double vision
  • Dizziness
  • Vertigo (room is ‘spinning’)
  • Sudden falling with complete recovery in seconds to minutes (“drop attacks”)
  • Difficulty speaking
  • Ringing in the ears (tinnitus)
  • Vision loss in one or both eyes
  • Fluctuating low-tone hearing loss
  • General weakness

Ocular migraine – also called ophthalmic or retinal migraine

Ophthalmic (retinal) migraine involves repeated episodes of a blind spot or blindness in one eye, usually lasting less than one hour and usually followed by headache. The headache may or may not have a ‘migraine’ quality. It may be simply a dull ache behind the eye that lost vision or it may cause pain in the entire head. A diagnosis of ocular migraine requires a normal eye exam between attacks. In other words, the problem cannot be (is not) in the eye itself.

Hemiplegic migraine – also called familial hemiplegic migraine

Familial hemiplegic migraine or hemiplegic migraine is a subtype of migraine with aura. Hemiplegic migraine is without a family history of same is rare, and probably results from a spontaneous genetic defect. Generally it is an autosomal dominant form of migraine that begins during childhood and which is characterized by extended paralysis of all or part of one side of the body (hemiplegia) that is accompanied by numbness, language difficulty (aphasia: difficulty producing or comprehending written or spoken words) and confusion.

The hemiplegia may start before, during or after the headache phase, and generally lasts from 24 hours to as long as a week. When originating before the headache, the hemiplegia is followed by headache within an hour, usually on the side opposite to the hemiplegia. Hemiplegic migraine is an example of “complicated migraine.” (The migraine is associated with neurologic signs or symptoms that persist beyond the head pain.) Like all complicated migraine, it has dramatic focal features and a persistent neurologic deficit that remains for at least 24 hours after the headache.

Ophthalmoplegic migraine

Ophthalmoplegic (OP) migraine is another rare form of “complicated migraine”. As suggested by the name, OP migraine includes features of both ocular and hemiplegic migraine. OP migraine is characterized by a severe unilateral headache that is associated with pain around the eye and paralysis in the muscles that surround the eye. Recurrent attacks may cause permanent damage. Other symptoms may include droopy eyelid, double vision and other visual problems.

Ophthalmoplegic migraine is believed to result from inflammation of the oculomotor nerve, and might therefore be categorized as a type of neuritis rather than as migraine. The course of individual attacks also suggests neuritis as opposed to migraine – symptoms can last for months.

OP migraine is usually diagnosed in childhood. In addition to those symptoms related directly to the oculomotor nerve, OP migraine is associated with severe one-sided (unilateral) headache. ves. Ophthalmoplegia may precede, accompany, or follow the headache; recurrent episodes may cause permanent oculomotor deficit.

Acephalic migraine – also called silent migraine or migraine equivalent

Acephalic migraine is aura without headache. The most common form of aura in silent migraine is visual. Silent migraine most often affects women. A positive family history of migraine is essential in confirming the diagnosis. Acephalic migraine may be a variation of ophthalmic migraine.

Status migrainosus

In contrast to migraine without headache, status migrainosus is a migraine headache lasting longer than seventy-two hours. While not really a separate entity, status migrainosis merits special attention. Sufferers may become dehydrated, especially when the headache is accompanied by vomiting. Hospitalization may be required, either for pain control or medical treatment such as IV rehydration.

Forms of migraine seen most often or exclusively in children

Migraine disease in childhood may differ substantially from that seen in adults. The time course is different, often shorter, and unique symptoms may be present. Headache is less often a central feature and, when present, is more often on both sides of the head. There is debate over whether certain conditions represent ‘true’ migraine, and some conditions are referred to as “migraine equivalents”. Migraine equivalents often go unrecognized or are misdiagnosed. They are often forerunners of the typical migraine. Migraine equivalents and complicated migraine in children may alternate with more typical migraine types.

Abdominal migraine

Abdominal migraine is characterized by recurrent bouts of generalized abdominal pain, often associated with general nausea and vomiting, but without headache. Abdominal migraine may alternate with typical migraine. it gradually lessens in most children with advancing age and is most often ‘replaced’ by the occurrence of typical migraine. Abdominal migraine is the most common form of atypical migraine in children.

Confusional migraine

Confusional migraine is uncommon. It most often occurs in the second decade of life. Attacks are sometimes precipitated by minor head trauma and are characterized by the rapid development of confusion and agitation. When affected by confusional migraine, children express a variety of symptoms and may become delirious, restless and/or combative. They may appear to be in pain but do not complain of headache. Attacks generally last less than 6 hours and are followed by deep sleep. Upon awakening, the child is normal and, most remarkably, has no memory of the time during the attack. The confusional migraine attacks tend to recur over months to years, but are eventually replaced by typical migraine in most children. This form of migraine is often very difficult to diagnose and is often misdiagnosed as a psychiatric or behavioral problem.

Migraine-associated cyclic vomiting syndrome – also called periodic syndrome

There is substantial debate over the relation of this condition to migraine. The syndrome is characterized by recurrent periods of intense vomiting separated by symptom-free intervals. Migraine-associated cyclic vomiting most often manifests with a rapid onset, often in early morning hours. Symptoms usually last 6-48 hours. Associated symptoms may include abdominal pain, nausea and lethargy. Symptoms more commonly associated with typical migraine may also occur, such as extreme sensitivity to light (photophobia) and sound (phonophobia.) Headache occurs in roughly 40% of attacks, but is more often associated with bouts of cyclic vomiting as the child becomes older.

This syndrome most often begins when the child is a toddler and continues through adolescence or early adulthood. It may rarely begin during the adult years. Girls are more often affected than boys. There is usually a family history of migraine. Some children with cyclic vomiting syndrome respond to antimigraine drugs.

Benign paroxysmal vertigo of childhood

Paroxysmal means that there is sudden onset of symptoms. Benign means that the condition does not result from and is not caused by some other condition, especially that it is not an indication of a more serious condition or disease.

Benign paroxysmal vertigo (BPV) is characterized by short periods of vertigo (room is ‘spinning’.) Balance is affected and nausea results. BPV is most often diagnosed in children between the ages of 2 and 6. BPV is not associated with hearing loss, tinnitus (ringing in the ears) or loss of consciousness. Symptoms usually last only a few minutes. Children with BPV often develop typical migraine as they grow older.

Paroxysmal torticollis of infancy

Torticollis defines a condition in which the neck is twisted, the head is tipped to one side, while the chin is turned to the other and generally pressed against the shoulder area.

Paroxysmal torticollis of infancy is a rare disorder characterized by repeated episodes of such head tilting that is associated with nausea and vomiting, as well as signs indicating headache. Attacks occur only during infancy and last from hours to days. it is reported that infants with this condition are more likely to develop typical migraine as they grow older.

Primary vs. secondary headache

The vast majority of headache is of ‘benign’ origin. Benign meaning that they are self-limiting (they will eventually go away on their own) and do not indicate that anything ‘worse’ is going on.

Primary Headache:

‘Primary’ headaches are those that do not result from another cause (e.g. intra-cranial bleeding, tumor.) Differentiating between migraine, tension-type, and cluster headaches (all of which are primary headaches) is important, as optimal treatment may differ. However, more important is knowing when to suspect the possibility of secondary headache.

Secondary Headache:

Secondary headache is headache that is caused by or results from another disease or condition. Any of the following features suggest the possibility of headache as a secondary disorder and warrant further investigation:

  • Unusual history or unusual character of headache.
  • Age over 40 at time of first migraine.
  • Headache is ‘new’, ‘different’ or substantially worse than what has previously been experienced.
  • A change (especially sudden change) in the character of the headache, either in intensity, duration or frequency.
  • Abnormal or unexpected neurological symptoms.
  • Headaches associated with other neurological signs or symptoms (eg, diplopia, loss of sensation, weakness, trouble walking or standing) or those of unusually sudden onset.
  • Headaches that are persistent (especially beyond 72 hours), or that develop after head injury or other trauma.
  • Headaches that are associated with stiff neck or fever.
  • Immediate, very rapid onset of severe headache – sometimes referred to as a “thunderclap headache.”

The “thunderclap headache” typically reaches peak intensity within 60 seconds. Left unattended, it may resolve over several hours – but it should not be left unattended. Thunderclap headache may represent a true medical emergency. In about 25% of cases it is caused by bleeding into the brain that can result in permanent damage or death if not promptly treated. Emergency medical care should be obtained.

One type of bleeding into the brain is called a sub-arachnoid hemorrhage. This almost always results in severe headache – typically described as “the worst headache of my life” and is often associated with a stiff neck, photophobia, nausea, vomiting, and possibly alteration of consciousness. Sub-arachnoid hemorrhage may result in a “thunderclap” headache, or it may develop somewhat more gradually.

Space occupying lesions (e.g. tumors) are another rare cause of headache, but may be missed as the symptoms sometimes mimic those of migraine (but much more often appear as “tension type” headaches.) In a recent extensive study, all patients with tumor-caused headaches that were similar to migraine had unusual symptoms such as excessively long headaches, a dramatic increase in headache frequency, new onset of seizures, confusion, prolonged nausea, and partial paralysis. This again emphasizes the need to investigate unexpected changes in headache frequency, duration or character.

It is important to note that many non-migraine headaches can respond to triptan therapy. Triptans may decrease headache pain associated with viral and bacterial infections and subarachnoid hemorrhage (bleeding into the brain.) When other symptoms raise concerns, the fact that a headache responds to an anti-migraine drug should not be taken as proof that it is a migraine.

Perspective on menstrual migraine

About 60% of women who have migraine experience attacks before or during their menstrual period, although only about 10% to 15% will have migraine only when they have their menstrual period. The majority of women will have migraine at other times of their cycle but will experience attacks of greater severity one to two days before or during their menstrual period.

Episodic migraine. How common is migraine? How many attacks on average?

About 5% of the US population has 18 or more days/year of migraine.

Median attack frequency is 1.5/month.

Roughly 6% of men and about 15% of women have migraine disease.

About 35% of those with migraine have…

Perspective on chronic migraine

Migraine can be characterized as a chronic disorder with episodic attacks and the potential for progression to chronic migraine.

Unlike other neurological disease, migraine does not worsen over time as a matter of course. Migraine may be stable. It may diminish in frequency or severity. Or migraine can worsen, most often gradually, until the chronic pattern emerges.

Migraine progression to chronic migraine is not the norm. Migraine is more likely to be stable, or to remit (especially over age 50.) Nonetheless, migraine progression is not uncommon. Because it is associated with severe impairment, it deserves special attention.

Five stages of migraine

Migraine is a common and often debilitating neurovascular disease affecting up to 35 million people in the US. Despite its relative frequency and oft times severity, migraine remains under-diagnosed, under-treated and poorly understood. One source of misunderstanding might be that “migraine” is so often equated with “headache.” In fact there are many who continue to believe that migraine is “just a bad headache.”

So rather than risk perpetuating that myth by jumping straight to the headache part of migraine disease, let’s look at the five stages of migraine as they occur.

Chronic migraine

Chronic migraine is migraine headache more than 15 days/month.

Also called “migraine transformation” because in most it begins with episodic migraine – the migraine pattern then gradually transforms to one of near daily headache.

Near constant headaches are often a mix of migraine and ‘tension-type’ headaches.

Approximately 1% of adults meet the criteria for chronic migraine.

90% of chronic migraine patients are women who first had episodic migraine without aura.

Up to 30% of those with migraine may eventually develop chronic migraine.

Prevalence of headache in the United States and its impact

Headache is extremely common:

Studies show 76 percent of women and 57 percent of men report at least one significant headache per month.

In the United States, an estimated 60 million to 80 million people experience recurring headaches (but only 30 percent of these people seek help, in many cases due to fear of being accused of “faking” the headache or being thought mentally ill.)