How Should We Define Chronic Migraine?

New research concludes that the current definition of chronic migraine does not account for differences in disability

Doctors define chronic migraine as having 15 or more headache days per month. Of those, at least eight of them should have migraine features. However, a recent study found that the current definition of chronic migraine does not reflect substantial differences in disability faced by migraine patients.

The study, which used exclusive American Migraine Foundation (AMF) data, was recently presented with the prestigious Harold G. Wolff Lecture Award from the American Headache Society (AHS) for the best paper on headache, head or face pain. We spoke to its authors on the importance of this research and what it means for those living with migraine.

Implications for people living with migraine

The frequency of headache days has long been a measure of disease burden for patients. In addition, it’s an indicator for what type of treatment methods they should explore. This study, however, looked at disability, pain intensity and impairment across the spectrum of headache frequency. It found patients with 8–14 headache days a month had similar levels of disability as patients with 15–23 headache days. Moreover, people with 24 headache days (or more) a month had the highest level of disability.

“This suggests that the 15-day threshold separating episodic and chronic migraine does not adequately reflect disease burden and treatment need,” said Dr. Ryotaro Ishii, study lead author and visiting scientist at the Mayo Clinic Arizona. “Moreover, patients who have a very high frequency of headache—24 or more days per month—may represent a unique and even more disabled subgroup.”

This research will facilitate more appropriate access to and selection of treatments for those significantly impacted by this disease. “This study will also facilitate a change in the way patients with migraine are currently classified, and remove barriers to the most appropriate and best available treatments for patients who are severely impacted by their disease,” said Dr. David Dodick, Professor of Neurology at the Mayo Clinic College of Medicine and co-principal investigator of American Registry for Migraine Research (ARMR).

The analysis of that data can lead to more effective treatments for migraine. “These registries will allow doctors to refine diagnoses, observe treatment responses and ultimately allow for personalized treatment—avoiding the current trial-and-error approach that is both time-consuming and frustrating,” said Dr. Lawrence Newman, Chair of AMF and Professor of Neurology at NYU Langone Health.

Patient-Centered Research

Data for this study came from the AMF’s ARMR, which collected information and biospecimens from patients living with migraine. ARMR helped healthcare providers and scientists better understand the causes, characteristics, and management of migraine and other headache types.

The recognition of Dr. Ishii’s research underlines the importance of databases like ARMR and the importance of patients participating in such registries. “Collecting information directly from patients with migraine allows researchers to truly understand the nuances of migraine and the impact that it has on the lives of those with migraine,” said Dr. Todd Schwedt, Professor of Neurology at the Mayo Clinic Arizona, and co-principal investigator of ARMR. “This can help researchers analyze this data and create personalized treatment plans that were never before possible.”

Ultimately, this study and the existence of large patient registries provide hope to the migraine community. “Migraine impacts everyone differently, and this research into the classification of migraine further reinforces the work the American Migraine Foundation has done to allow for the personalization of migraine care,” said Nim Lalvani, AMF Executive Director.

Researchers are working every day to find more effective treatments for migraine. But this research is not possible without your help. Your donation will support the millions of people living with migraine and help them get back to doing the things they love.