Worldwide, the prevalence of chronic migraine (CM) is about two percent. Based on the United States census population figures, that translates to 6,409,841 people with chronic migraine in the United States alone. The International Headache Society's International Classification of Headache Disorders, 3rd edition (ICHD-3), defines chronic migraine as 15 or more migraine and headache days, with at least eight of those being migraine, over a period of at least three months. The average cost of chronic migraine, most of which is due to loss of productive time, is estimated at $7,750 per person per year. That's nearly four and one-half times the estimated cost of episodic migraine (EM).
We don't totally understand yet why episodic migraine transforms to chronic migraine. One theory is that increased frequency of migraine attacks causes the trigeminal system and affected neuronal systems to become sensitized, which reduces their threshold for activation. In other words, an increased ...
The migraine topic about which I see the most questions is whether specific acute migraine medications (the medications we use when we get a migraine) work. The problem with those questions has been that nothing works for all migraineurs, so the answers have been along the lines of, "It works for some people. The only way to know is to try it."
Now, thanks to a study conducted and published by American Headache Society researchers, the evidence from other studies on the efficacy of acute treatments has been gathered and assessed. Their assessment resulted in acute treatments being categorized in a fashion that at least shows which acute treatments have the most evidence of being effective and which may be ineffective.
"The study aims to provide an updated assessment of the evidence for individual pharmacological therapies for acute migraine treatment." 1
"Pharmacological therapy is frequently required for acutely treating migraine attacks....
When the most often prescribed acute treatments for migraine fail, patients and doctors alike want to know why. In fact, such issues are so important to doctors and researchers that there was an entire special issue of the journal Headache devoted to the gastrointestinal manifestations of migraine. One research paper in this issue dealt specifically with why triptan treatment can fail.
"Results of randomized, double-blind, controlled studies establish the efficacy of triptans in the acute treatment of migraine, but triptan benefits demonstrated in clinical trials have not consistently been realized in clinical practice. This paper explores the contribution of gastrointestinal manifestations of migraine – namely nausea (with or without vomiting) and gastroparesis – to triptan treatment failure."
Triptans for Migraine:
There are seven triptans available for the acute treatment of Migraine available in a variety of formulations.
All of the...
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