Mungoven Tiffani J, Henderson Luke A, Meylakh Noemi
Department of Anatomy and Histology, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
Front Pain Res (Lausanne). 2021 Aug 25;2:705276. doi: 10.3389/fpain.2021.705276. eCollection 2021.
Chronic migraine is a disabling neurological disorder that imposes a considerable burden on individual and socioeconomic outcomes. Chronic migraine is defined as headaches occurring on at least 15 days per month with at least eight of these fulfilling the criteria for migraine. Chronic migraine typically evolves from episodic migraine as a result of increasing attack frequency and/or several other risk factors that have been implicated with migraine chronification. Despite this evolution, chronic migraine likely develops into its own distinct clinical entity, with unique features and pathophysiology separating it from episodic migraine. Furthermore, chronic migraine is characterized with higher disability and incidence of comorbidities in comparison to episodic migraine. While existing migraine studies primarily focus on episodic migraine, less is known about chronic migraine pathophysiology. Mounting evidence on aberrant alterations suggest that pronounced functional and structural brain changes, central sensitization and neuroinflammation may underlie chronic migraine mechanisms. Current treatment options for chronic migraine include risk factor modification, acute and prophylactic therapies, evidence-based treatments such as onabotulinumtoxinA, topiramate and newly approved calcitonin gene-related peptide or receptor targeted monoclonal antibodies. Unfortunately, treatments are still predominantly ineffective in aborting migraine attacks and decreasing intensity and frequency, and poor adherence and compliance with preventative medications remains a significant challenge. Novel emerging chronic migraine treatments such as neuromodulation offer promising therapeutic approaches that warrant further investigation. The aim of this narrative review is to provide an update of current knowledge and perspectives regarding chronic migraine background, pathophysiology, current and emerging treatment options with the intention of facilitating future research into this debilitating and largely indeterminant disorder.
慢性偏头痛是一种致残性神经疾病，给个人和社会经济成果带来了相当大的负担。慢性偏头痛的定义为每月至少有15天出现头痛，其中至少8天符合偏头痛的标准。慢性偏头痛通常由发作性偏头痛演变而来，其原因是发作频率增加和/或与偏头痛慢性化相关的其他几种风险因素。尽管有这种演变，但慢性偏头痛可能发展成为其自身独特的临床实体，具有将其与发作性偏头痛区分开来的独特特征和病理生理学。此外，与发作性偏头痛相比，慢性偏头痛的特点是残疾程度更高且合并症发生率更高。虽然现有的偏头痛研究主要集中在发作性偏头痛上，但对慢性偏头痛病理生理学的了解较少。越来越多关于异常改变的证据表明，明显的功能性和结构性脑变化、中枢敏化和神经炎症可能是慢性偏头痛机制的基础。目前慢性偏头痛的治疗选择包括危险因素修正、急性和预防性治疗、基于证据的治疗，如肉毒杆菌毒素A、托吡酯以及新批准的降钙素基因相关肽或受体靶向单克隆抗体。不幸的是，这些治疗在中止偏头痛发作以及降低强度和频率方面仍然主要无效，而对预防性药物的依从性和顺应性差仍然是一个重大挑战。新出现的慢性偏头痛治疗方法，如神经调节，提供了有前景的治疗途径，值得进一步研究。本叙述性综述的目的是提供关于慢性偏头痛背景、病理生理学、当前和新出现的治疗选择的最新知识和观点，以便促进对这种使人衰弱且在很大程度上尚不明确的疾病的未来研究。
