Migraine is typically broken into two categories: episodic and chronic. To the uninitiated, it appears that episodic migraine means attacks happen infrequently, while chronic migraine means they are constant. But the reality is far blurrier than that.
High-frequency episodic migraine is far more similar to chronic migraine in terms of level of disability and quality-of-life impact than it is to infrequent episodic migraine, according to a new study. This study analyzed charts of 1,109 people with migraine; 855 had episodic migraine and 254 had chronic migraine. The main findings and recommendations are:
- People with high-frequency episodic migraine (10 or more headache days a month) have more similar migraine characteristics as those with chronic migraine than those with low-frequency episodic migraine.
- People with high frequency episodic migraine experience a similar level of physical disability and emotional impact as those with chronic migraine.
- People with high-frequency episodic migraine should have all treatment options available to them, including those that are typically reserved for chronic migraine, like Botox.
This study only used three categories: low-frequency episodic migraine (less than 10 headache days a month), high-frequency episodic migraine (10 or more headache days a month), and chronic migraine (15 or more headache days a monh). Others use three categories for episodic migraine, where low-frequency episodic migraine is characterized by 0 to 4 headache days a month, and moderate-frequency episodic migraine is 5 to 9 headache days a month. (I know it’s more common for patients to talk about migraine days instead of headache days, but researchers still talk in headache days.)
It’s good to see that researchers are beginning to look beyond the overly simple categories of episodic and chronic migraine. Looking at the real impact of migraine on people’s lives illustrates just how inadequate those categories are.
A woman once told me that she has two migraine attacks a month and as soon as she’s over the first one, the next one has begun. The temptation to compare is strong (especially for someone with daily migraine attacks), but all that really matters here is the perceived quality of life impact for each individual person. The objective number is less important the subjective experience of living with migraine.
Torres-Ferrús, M.; Quintana, M.; Fernandez-Morales, J.; Alvarez-Sabin, J.; & Pozo-Rosich, R. (2016). When Does Chronic Migraine Strike? A Clinical Comparison of Migraine According to the Headache Days Suffered Per Month. Cephalalgia, first published on March 8, 2016 as doi:10.1177/0333102416636055.