Migraine - Chronic vs. Chronic

International Headache Society classifies Migraine as one of the most disabling disorders worldwide. “Migraine is a common disabling primary headache disorder. Epidemiological studies have documented its high prevalence and high socio-economic and personal impacts. In the Global Burden of Disease Survey 2010, it was ranked as the third most prevalent disor-der and seventh-highest specific cause of disability worldwide” [1].

European headache alliance, EHA, declared in the Madrid Manifesto from 2010

“The World Health Organization places migraine as the 12th leading cause of disability in women and 19th overall. Migraine affects 12-15% of the population. It costs the EU economy approximately €27 billion annually due to reduced productivity and workdays lost. Failure of healthcare systems to provide effective treatments to those who need them is the most signifi-cant reason for this socio-economic burden [2].

The American Migraine Foundation has launched the 36 Million Migraine Campaign. This is a national public mobilization and education campaign to increase awareness and research in-vestment in migraine-a disorder that affects more than 36 million Americans. The purpose of the 36 Million Migraine Campaign is to make migraine a US national health priority [3].

The Swedish Migraine Association has launched a campaign with the same idea as the American-“Recognise migraine as a chronic neurologic disorder!” We wrote letters to the General Directors of some strategic national authorities. We have already seen some results. The Labour market authority declared that migraine and epilepsy shall be regarded as a somatic related disability, which causes declined capacity to work. The common explanation among the public but also many civil servants has been that migraine is a psychological problem.

I have read a lot of articles and listened to a lot of scientific lectures from neurologists and pain doctors on headache disorders. They describe different types of headaches and what is typical for each of them. When it comes to the origin of the headache disorders they are not so sure. Migraine is to 60-80% genetic, depending on if there is migraine in one or both parents’ backgrounds. But is migraine a brain or neurologic disorder or anything else?

The American Migraine Foundation: “Migraine is an inherited neurological disorder that is characterized by hyperexcitable brain networks that may be triggered by a variety of stimuli---leading to attacks.”

European Headache Alliance, EHA, declared in the Madrid Manifesto that “Migraine is a neurological disorder of the brain”.

The Swedish neurologist and specialist in headache disorders Professor Carl Dahlöf has in the next magazine, The Head Journal, of the Swedish Migraine Association written: “Migraine is a chronic, partly genetic disorder. ---Migraine is one of the most common neurological dis-orders and we estimate that 45 million persons in Europe have this disorder.”

In order to get more knowledge I visited the web page of International Headache Society, HIS [4], which is the organization who is responsible for the classification of different headache diagnosis on behalf of WHO.

IHS has organized the different headache diagnosis in three main groups – primary, secondary and others. Primary headache is divided into - migraine, tension type headache, Cluster headache and other primary headaches. Migraine is divided into migraine with and without aura and four other types [5].

The classification develops all the time due to new research and experiences. Thus we can today read the following in the ICHD-3 beta version:

“Fortunately, big changes have not been necessary, but a fairly large number of small but important changes have been made in the light of new evidence. Thus, we have introduced 1.5.1 chronic migraine as a new diagnosis for those rare patients who fulfill the diagnostic criteria for migraine for 15 or more days a month without overusing medication.” This is the first time “chronic” is mentioned in connection with migraine in the classification. I don’t agree that chronic migraine is a rare disorder. In Sweden experts have calculated that 200,000 persons have chronic migraine.

I have chosen my headline “Migraine – chronic vs. chronic” because there has been a big confusion when we on the one hand talk about migraine as a chronic neurological disorder and on the other hand about chronic migraine.

What does the word chronic mean. I have found a good definition at the website of the centre for managing chronic disease [5]. ”Chronic Disease is a long-lasting condition that can be controlled but not cured.”

Many persons with migraine are very negative to the word “chronic”. They long for and wish to be fresh and healthy and if their disorder is chronic they think it’s hopeless. Therefore some of them instead have started to talk about episodic migraine. But that’s another dimension.

I think it’s very important to state that Migraine is a chronic neurological disorder. Almost all professionals in the headache field, medical boards and headache associations are of the same opinion. The problem occurred when IHS invented the diagnosis chronic migraine. I would prefer another name instead of chronic migraine for example serious migraine.

President of the Swedish Migraine Association since 2010, Board member of European Headache Alliance, EHA, since 2011.