Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
Nat Rev Neurol. 2016 Aug;12(8):455-64. doi: 10.1038/nrneurol.2016.93. Epub 2016 Jul 8.
Chronic migraine has a great detrimental influence on a patient's life, with a severe impact on socioeconomic functioning and quality of life. Chronic migraine affects 1-2% of the general population, and about 8% of patients with migraine; it usually develops from episodic migraine at an annual conversion rate of about 3%. The chronification is reversible: about 26% of patients with chronic migraine go into remission within 2 years of chronification. The most important modifiable risk factors for chronic migraine include overuse of acute migraine medication, ineffective acute treatment, obesity, depression and stressful life events. Moreover, age, female sex and low educational status increase the risk of chronic migraine. The pathophysiology of migraine chronification can be understood as a threshold problem: certain predisposing factors, combined with frequent headache pain, lower the threshold of migraine attacks, thereby increasing the risk of chronic migraine. Treatment options include oral medications, nerve blockade with local anaesthetics or corticoids, and neuromodulation. Well-defined diagnostic criteria are crucial for the identification of chronic migraine. The International Headache Society classification of chronic migraine was recently updated, and now allows co-diagnosis of chronic migraine and medication overuse headache. This Review provides an up-to-date overview of the classification of chronic migraine, basic mechanisms and risk factors of migraine chronification, and the currently established treatment options.
慢性偏头痛对患者的生活有很大的不利影响，严重影响社会经济功能和生活质量。慢性偏头痛影响普通人群的 1-2%，约 8%的偏头痛患者；它通常由发作性偏头痛每年以约 3%的转化率发展而来。这种慢性化是可以逆转的：约 26%的慢性偏头痛患者在慢性化后 2 年内进入缓解期。慢性偏头痛最重要的可改变的危险因素包括急性偏头痛药物的过度使用、无效的急性治疗、肥胖、抑郁和生活压力事件。此外，年龄、女性和低教育程度会增加慢性偏头痛的风险。偏头痛慢性化的病理生理学可以理解为一个阈值问题：某些易患因素，加上频繁的头痛疼痛，降低了偏头痛发作的阈值，从而增加了慢性偏头痛的风险。治疗选择包括口服药物、局部麻醉剂或皮质类固醇的神经阻滞以及神经调节。明确的诊断标准对于识别慢性偏头痛至关重要。国际头痛协会最近更新了慢性偏头痛的分类，现在允许同时诊断慢性偏头痛和药物过度使用性头痛。这篇综述提供了慢性偏头痛分类、偏头痛慢性化的基本机制和危险因素以及目前已确立的治疗选择的最新概述。
