Hope for Chronic Migraine Patients

By Stephen H. Landy, MD, FAHS

Approximately 3.2 million Americans, predominately women, suffer from CM. Only 20% receive an accurate diagnosis. For the migraine sufferer, who remains undiagnosed, the condition is frequently associated with devastating disability and burdensome financial consequences—including missed work days, coupled with repeat emergency room visits. In some instances, the emergency room visits result in nonproductive, medical evaluation and treatment.

Thankfully, tremendous advances have been made in neurology, including headache medicine and specifically CM. In 1982, Ninan Matthew, M.D. published compelling evidence suggesting that episodic migraine can transform into a chronic daily headache pattern, and this transformation may be a continuum of the migrainous process in some unfortunate patients.

In 2004, the International Classification of Headache Disorders, 2nd edition, recognized CM as a complication of migraine. Since then, we have witnessed an unprecedented understanding of CM diagnosis, epidemiology, pathophysiology, comorbidity, sociodemographic, economic and humanistic burden issues. With more information available regarding CM, most neurologists and all headache experts are now capable of diagnosing and effectively treating CM patients.

In October, 2010, the Food and Drug Administration (FDA) approved BOTOX ® as the the first and only FDA-approved preventive treatment for people with CM. Subsequently, this approval has increased awareness of this disabled patient population and continues to stimulate appropriate research and proper diagnosis and treatment for the disorder.

Numerous other CM treatments, including non pharmacologic and pharmacologic, are readily available, and interest by all healthcare stakeholders including patients, providers, insurers and employers has never been greater. With increased awareness and discussion of CM comes the recognition of the seriousness of the disorder. Logically, increased stakeholder concern and understanding should translate into increased hope for the millions of people living with CM worldwide.

Stephen H. Landy, MD, FAHS, Founding Partner, Wesley Neurology & Headache Clinic, Memphis, TN.