In this issue – the first of 2008 – is included a special section that examines in detail a topic of immense relevance to the public health: migraine “chronification.”
As many as 8 million Americans suffer from chronic migraine, and general population studies involving other nations have demonstrated a prevalence rate equal to or approximating that recorded in the United States. Seminal work by Mathew, Silberstein, Lipton, and others has assisted in defining the epidemiology of what until recently was most often termed “transformed” migraine, but we continue to lack much in the way of data that would enable us to understand the origins of this common migraine complication and its optimal management.
One cannot attribute migraine chronification simply to overuse of symptomatic medication; while such overuse is common in individuals with chronic migraine, it is far from invariable and, even when present, is likely to represent consequence rather than cause. So often in medicine when we are confronted with a common, clinically vivid and baffling disorder, we resort to one of 2 solutions to “explain” that disorder's pathogenesis: blame it on the patient (or the patient's parents – eg, autism), or simply affix the label “idiopathic” (a tautologic sleight-of-hand that translates as “we don't know”). Like the rash of measles, chronic migraine differs little in its clinical phenotype from patient to patient, but the patients themselves are a diverse lot; and just as measles is neither “idiopathic” nor patient-induced, so may we come to find that chronic migraine possesses origins presently obscure to us . . . and quite different from what we might have anticipated.
In selecting subtopics and contributing authors, the section's editors, Drs. Penzien, Rains, and Lipton, have chosen well. The result is nothing less than a full-spectrum summary of what we currently know – and do not know – regarding this vexingly common disorder that fills the waiting rooms of subspecialty headache clinics, claims a substantial share of our health-care resources, and drains those afflicted of their productivity and emotional well-being.