Mayo Clinic Proceedings:The Evolution of Migraine from Episodic Headache to Chronic Disorder

Patients living with migraine have strong reason for new optimism concerning a positive future. Two review articles and an accompanying editorial, "The Future of Migraine: Beyond Just Another Pill," in the current issue of Mayo Clinic Proceedings, are the basis for an ironic premise.

"Migraine is a potentially chronic, progressive disease that substantially affects patients, families, workplaces, and society," according to the editorial written by Roger Cady, M.D., of the Headache Care Center in Springfield, Mo. "Ironically, this is the springboard for renewed optimism of a more positive future for patients living with migraine."

Traditionally, Dr. Cady explains, migraine has been considered a pain disorder involving separate or even sporadic episodes. Now, the condition is defined as an all-encompassing and progressive disease that negatively affects all aspects of an individual's life. Migraine can erode quality of life during what should be a person's most productive years, according to Dr. Cady. Because migraine patients' quality of life has not improved at a pace with medical advances, research is addressing the overall severity and potential progressive nature of migraine, especially migraine episodes as a forerunner of chronic migraine.

According to the three articles, these new insights and understandings are requiring professionals to explore well beyond traditional migraine management. "Understanding migraine as a potentially chronic disease mandates a collaborative health care model with patients and health care professionals working in a partnership toward common therapeutic goals," writes Dr. Cady, specifically intervention and prevention.

Physicians and patients must be encouraged to be partners, he says, and evaluation must go far beyond the physician just asking, "How are your migraines?" The models must include an invitation to comprehend and address all migraine-related health issues facing patients, Dr. Cady writes. In addition, understanding the evolutionary "stages" of migraine from sporadic to persistent offers an opportunity to develop new therapies that individualize and personalize care.

In the future, successful management of migraine will ideally be measured not by stopping an attack but by overall disease management and prevention, according to the researchers.

This new understanding of migraine as a chronic disease offers many challenges and rewards, according to Dr. Cady. "Today, the focus of care is rapidly changing from the event of the migraine to the patient with migraine," he notes. These changes present great promise for patients and health care professionals alike, representing assurances of a better future for patients with migraine, concludes Dr. Cady.

A peer-reviewed journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at www.mayoclinicproceedings.com/.
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