Chronic Migraine (Headache): G43.0

Chronic Migraine (Headache): G43.0

Prevalence of Chronic Migraine
Chronic migraine affects approximately 14% of the global population, with a higher incidence among women. Typically, migraines onset in one’s teens to twenties, peak in severity and frequency between ages 30-45, and often diminish by ages 55-60. However, some individuals continue to experience typical migraine attacks even beyond age 50.

Understanding Migraine
Migraine is a primary headache disorder characterized by pulsating headaches lasting 4-72 hours, accompanied by heightened sensitivity to light and sound, as well as nausea and/or vomiting.

Chronic Migraine – Among the Most Common Causes of Recurring Headaches
One may suffer from chronic migraine if:

  • Headache frequency exceeds 15 days per month.
  • ≥8 headache days per month meet migraine criteria without aura.
  • (At least 4 of the following: unilateral pulsating headache, aggravated by physical activity, accompanied by at least 2 of: light/sound sensitivity, nausea and/or vomiting).
  • Migraine with aura (diagnosed by a physician).
  • Headache relieved by migraine-specific medications (triptans).
  • History of at least 5 attacks of migraine with or without aura.

Diagnosis and Treatment of Migraine

Untreated or ineffectively treated headaches should persist for at least 4 hours. If the duration is shorter, consulting a doctor is advised to rule out other types of headaches necessitating neurological evaluation.

Migraine headaches typically worsen with physical activity and manifest as severe pulsating pain. Aura migraines, less common than those without aura, are characterized by visual disturbances, numbness, or speech impairments preceding the onset of pain.

Migraine attacks can be triggered by various factors, including dietary habits, hormonal fluctuations, psychological stressors, weather changes, physical exertion, and environmental stimuli.

Migraine Diagnosis
Diagnosis is primarily clinical, relying on symptom analysis, medical history, and routine neurological examination. Maintaining a headache diary aids in distinguishing migraine attacks from other types of headaches and identifying medication overuse headache.

Migraine Treatment

Treatment aims to alleviate symptoms, prevent progression, and enhance quality of life through acute intervention and preventive therapy.

  • Acute Intervention: Involves reducing pain severity and duration, restoring general condition, and managing associated symptoms. This includes using analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), triptans, and ergotamine-containing medications. Triptans, taken at the onset of an attack, are particularly effective. However, caution is advised regarding their prolonged use to avoid medication-overuse headache.
  • Preventive Therapy: Seeks to reduce attack frequency and severity. Topiramate and botulinum toxin (Botox) are commonly used medications. Botulinum toxin is approved for preventive therapy in chronic migraine in certain cases.

Monitoring and Follow-Up
Individuals with chronic migraine require regular monitoring by a healthcare provider for 4-12 months, with frequent assessments to evaluate treatment efficacy and make necessary adjustments every two to three months.

Adherence to prescribed treatment regimens and regular follow-up visits are crucial for improved outcomes and better management of chronic migraine.