Chronic migraine: risk factors, mechanisms and treatment

Chronic migraine significantly impacts patients' lives, affecting their quality and socioeconomic functioning. It affects 1-2% of the general population and 8% of migraine patients. Chronic migraine usually develops from episodic migraine, converting at a rate of about 3% annually. Remarkably, 26% of chronic migraine patients can achieve remission within two years. Key modifiable risk factors for chronic migraine include overuse of acute medication and ineffective treatments. Other factors include obesity, depression, and stressful life events. Additionally, age, female sex, and low educational status increase chronic migraine risk. The underlying mechanisms of migraine chronification involve a threshold problem. Certain factors lower the migraine attack threshold, increasing chronic migraine risk. Treatment options consist of oral medications, nerve blockade, and neuromodulation. Accurate diagnostic criteria are crucial for identifying chronic migraine. The International Headache Society's recent updates allow co-diagnosis of chronic migraine and medication overuse headache. Clinical relevance: This research highlights critical risk factors and treatment options for chronic migraine management.