Chronic and episodic migraine is a complex neurological condition with no single therapy or drug considered to cure it. According to Robert Cowan, a neurologist at Stanford University in California, chronic migraine may not be fatal, but "…it ruins your life. It's not a silent killer. It's a silent disabler." 

Migraines afflict more than a billion people worldwide. Symptoms vary between individuals, and migraine is the third leading cause of disability for people under 50.

Is it possible for people who suffer migraines to go into remission?

A Brief Overview of Chronic vs. Episodic Migraine and Remission

A person who suffers fewer than 15 headache days a month is considered to have episodic migraines. Someone who has more than 15 headache days a month has chronic migraines. The distinction is rough and is only meant as a differentiation for diagnostic purposes. 

Migraine diagnosis should be performed by a healthcare provider experienced in diagnosing and treating migraines and headaches.

Chronification

Chronification is a term used when someone who suffers episodic migraines experiences a steady increase in the number of headache days they experience a month. Someone with episodic migraine can eventually be diagnosed with chronic migraines. About 2.5% of episodic migraineurs become chronic during their lifetime. Only a quarter of chronic migraineurs move to episodic migraines or experience full remission.

Medication overuse may hasten chronification and reinforce it once it develops. The most common medications in these cases are opioids and barbiturates.

Remission

Remission of chronic or episodic migraine means the symptoms have decreased or disappeared. Remission does not mean the condition has been eliminated, only that the symptoms have been reduced or abated. However, even a partial remission can significantly improve the quality of life for a chronic migraineur.

Partial remission means that an individual with chronic migraine suddenly experiences fewer attacks. If they have ten or fewer headache days a month, the reduction may be termed a partial remission.

Full remission means the person with occasional migraine goes more than a year without a migraine attack. 

Why Someone Might Progress from Episodic to Chronic

A patient with episodic migraine might move towards a chronic condition for several reasons. 

• Comorbidities can worsen the condition for half of migraineurs. Depression is responsible for chronification in about one-third of cases, and anxiety may account for 17% of chronification.
• Chronic pain syndromes can double the probability of developing chronic migraine compared to episodic. People with back pain or post-concussion headaches have a higher risk of developing chronic migraines.
• Other factors may be predictive for developing chronic migraine, including obesity, poor sleep, low economic status, and a history of childhood sexual abuse or other trauma.

In short, we don't know as much as we need to about migraines and their causes. We don't fully understand why certain conditions seem to make the likelihood of developing migraine. However, we have a few clues and directions for research.

Can Someone Achieve Migraine Remission?

Some people with migraines go into remission, either partial or full, but doctors aren’t sure exactly why. Here are some potential reasons:

• Age - the number of monthly migraine attacks is likely to decrease over time, often for people over 40. For women, a reduction in hormone levels after menopause may be a factor.
• Biological sex - men are less likely than women to suffer migraines, but those who do are more likely to go into remission.
• Lack of a reaction to touch during a migraine - If a migraineur does not experience acute sensitivity to touch while suffering a migraine, they are more likely to achieve remission. Those who are highly sensitive to touch, to the point clothing is uncomfortable, are much less likely to do so.
• Chronic migraines - someone with chronic migraines are more likely to go into partial remission if they experience sharply reduced numbers of attacks. If they usually have 30 headache days a month and drop to 15, they are in partial remission.

There is no way of knowing which came first for those who have comorbidities. Are people depressed because they have migraines? Or do they suffer migraines because they are depressed? Correlation doesn’t necessarily mean causation.

Potential Areas of Study for Pathways to Remission

Some researchers found undetected leaks of cerebral spinal fluid (CSF), perhaps caused by injury or age, that seem to cause chronic migraine. Once the leak is patched, the patient has no further migraines. 

MRI studies of the brains of migraineurs compared to controls show specific changes in the thickness of layers in the cerebral cortex. Variations in thickness may be a harbinger of migraine susceptibility. The studies produced uneven results, but researchers continue to refine the studies.

Another research path shows that some migraineurs have a right amygdala that is demonstrably larger than the left. The amygdala is a structure in the limbic system that is involved in assigning emotional significance to sensory input. Those with chronic migraine reported more anxiety, fearing the migraines will continue to worsen. Researchers are studying whether moving from chronic to episodic migraine reduces amygdala size.

Studies of head trauma patients seem to respond better to a specific drug because the blood-brain barrier has already been compromised. Other researchers are trying to determine which part of various brain structures play a role in chronification. They are also looking at the effect that molecules like peptides have on the body.

The timing of treatment may be a factor in chronification and remission. For example, if a patient takes triptans to interfere with the serotonin neurotransmitter receptors in the brain, the migraine may stop in its tracks if given early enough. Once the headache spreads throughout the brain, triptans are not effective.

DHE, on the other hand, can help when a migraine has spread. It is becoming more commonly used as access and provision have been simplified. Interrupting a sensitization process can also stop chronification.

Living with Chronic Migraine

Until we find the proper treatment, therapy, or medication, there are things you can do to achieve a better quality of life. 

If you notice the frequency of migraines is increasing over weeks or months, seek medical attention immediately. It’s much easier to stop chronification with early intervention. Don’t wait for migraines to become a daily occurrence.

If you already suffer chronic migraines or chronification has advanced, treat the headache intensification early and aggressively, but avoid overusing any one medication or classification of medication. 

Get help from a healthcare provider to create a balanced plan for acute headache treatment. Begin lifestyle changes like aerobic exercise, dietary changes, and trigger identification and avoidance. Ask if a device like Cefaly, which helps desensitize the trigeminal nerve, is recommended for your condition.

Contact the Migraine Relief Center for more information if you need help with headache pain diagnosis and treatment.