More frequent with time?
For some individuals with migraine, the headaches become more frequent with time.
Although most people with migraine can look forward to eventual improvement, or at least stability of their migraine, migraine does worsen over time in some people. This has been called migraine progression.
A typical patient would be one who is referred to a neurologist in her forties with headache every day or almost every day. She describes to the doctor how in her teens and twenties she had typical migraine headaches which would come and go, with perhaps several attacks per month. Then, over time the headaches became more and more frequent, until they were occurring every day. The headaches at this point are often not as severe as the original migraine headaches on many days of the month, although there may be times when they become worse for a few days with the usual migraine headache accompaniments of nausea and light and sound sensitivity.
There appear to be two main reasons why people with migraine develop a chronic daily headache syndrome, by definition a chronic daily headache means headache on 15 days a month or more. One is overuse of acute pain medications such as analgesics, pain killers, ergotamines, and triptans. The triptans are the new more specific migraine medications, the first one of which was sumatriptan or Imitrex. There now are five other “triptans” on the market in Canada as well. When medication overuse is felt to be the cause, then the headache is appropriately referred to as medication overuse headache. If medication overuse is indeed the cause of the transformation of the person’s migraine to a daily headache pattern, then stopping the medication overuse should result in relief of the chronic daily headache. The person will usually still be left with the original intermittent migraine attacks. It seems that migraine sufferers are particularly prone to the development of a daily headache syndrome as a result of frequent pain killer use, no matter the reason for the painkiller use. This does not usually happen overnight, but takes at least a few months to develop. People without a headache disorder who use frequent pain killers do not seem to develop this condition.
Some people with migraine, a relatively small minority, appear to develop very frequent headaches and even a chronic daily headache syndrome without pain killer, ergotamine, or triptan overuse. This condition has been called chronic migraine. The reasons why this happens is not understood. One reason may be that frequent migraine headache attacks gradually sensitize the pain system so that eventually migraine head pain comes more and more easily. This has not been proven, but if some mechanism like this is the cause, then one could speculate that careful management of migraine over the years to minimize the number of attacks experienced might prevent the development of chronic migraine.
