Anatomy of a Headache

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Long-Acting Opioids for
Refractory Chronic
Migraine

Study results for a group
of difficult-to-treat
migraineurs provide a
basis for determining
efficacy and guidelines
for the use of long-term
opioids in this
population.

 

Heatherís Chronic
Migraine: an Interactive
Case History

This column will take you,
step by step, through
the diagnosis of a complex
headache patient with
the pseudonym of "Heather."

 

ROBBINS HEADACHE CLINIC

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Title:
Sociodemographic and Comorbidity Profiles of Chronic Migraine and Episodic Migraine Sufferers
Author:
Drs. D. Buse, A. Manack, et al
Date:
Posted: May 2010
Source:
Neurol Psychiatry  2010;81:428-432

According to a 2009 study, individuals who experience chronic migraine (CM) often have significantly lower levels of household income and are twice as likely to suffer from conditions including depression, anxiety and chronic pain.

It has long been established that CM can be an especially disabling and burdensome condition. Both clinical and population based studies have demonstrated that CM, in comparison with EM (episodic migraine), results in greater migraine-related disability, and impairment in headache related quality of life.

This study, conducted by Dr. Dawn C. Buse and associates at the Montefiore Headache Center in New York, included 24,000 headache sufferers, comparing CM (15 or more headache days per month) and EM (14 or fewer headache days per month) sufferers. Dr. Buseís findings showed multiple conditions were more common in the CM population including psychiatric (depression, anxiety, bipolar disease), respiratory (allergies/hay fever, asthma, COPD, sinusitis), cardiovascular and related risk factors: (angina, high cholesterol, obesity) and chronic pain. In fact, depression, chronic bronchitis, and ulcers were approximately twice as likely and chronic pain was 2.29 more likely in CM patients compared to EM sufferers.

The differences in the profiles between the two groups imply that CM and EM deviate not just in the degree of headache frequency but in these other important areas. These differences might provide important clues to further explore the differences between CM and EM. It is important for clinicians to maintain diagnostic vigilance and provide appropriate treatment or referrals when necessary.

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