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Modifiable Risk Factors for Migraine Progression (or for Chronic Daily Headaches)—Clinical Lessons


  • Marcelo E. Bigal MD, PhD,

  • Richard B. Lipton MD

  • From the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, The Montefiore Headache Center, Bronx, NY (Drs. Bigal and Lipton), and The New England Center for Headache, Stamford, CT (Dr. Bigal); Department of Neurology, Epidemiology and Population Health, Albert Einstein College of Medicine, and The Montefiore Headache Center, Bronx, NY (Dr. Lipton).

Address all correspondence to Marcelo E. Bigal, MD, PhD, Department of Neurology, The Albert Einstein College of Medicine, 1165 Morris Park Avenue, Bronx, NY 10461.


Herein we summarize clinical issues gleaned from a full peer-reviewed article on modifiable risk factors for migraine. Since migraine is progressive in some but not in most individuals, identifying patients at risk for progression is crucial. Key interventions include: (1) Decrease headache frequency with behavioral and pharmacologic interventions; (2) Monitor the body mass index and encourage maintenance of normal weight; (3) Avoid medication overuse; (4) Avoid caffeine overuse; (5) Investigate and treat sleep problems and snoring; (6) Screen and treat depression and other psychiatric comorbidities. These recommendations have not been demonstrated to improve outcomes in longitudinal studies.