Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Take the CME quiz
Right arrow CME: Take the course for this article:
 Volume 71, Number 11, September 9, 2008
Right arrow Podcast
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Google Scholar
Right arrow Articles by Bigal, M. E.
Right arrow Articles by Lipton, R. B.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bigal, M. E.
Right arrow Articles by Lipton, R. B.
Related Collections
Right arrow Migraine
NEUROLOGY 2008;71:848-855
© 2008 American Academy of Neurology
Views and Reviews

Clinical course in migraine

Conceptualizing migraine transformation

Marcelo E. Bigal, MD, PhD and Richard B. Lipton, MD

From the Department of Neurology (M.E.B., R.B.L.), Epidemiology and Population Health (R.B.L.), Albert Einstein College of Medicine, Bronx; Montefiore Headache Center (R.B.L.), Bronx, NY; and Merck Research Laboratories (M.E.B.), Whitehouse Station, NJ.

Address correspondence and reprint requests to Dr. Marcelo E. Bigal, Global Center for Scientific Affairs, Merck Research Laboratories, 1 Merck Drive, Whitehouse Station, NJ 08889 marcelo_bigal{at}merck.com

Migraine is currently conceptualized as a chronic disease with episodic manifestations, with attacks that increase in frequency in a subgroup (migraine transformation or progression). Transformation of migraine may be subdivided in three partially overlapping forms, although research in this area is still in infancy, and evidence is sometimes weak. Typically, transformation refers to increases in attack frequency over time leading to chronic migraine; this process is termed clinical transformation. Additionally, in some patients with migraine, physiologic changes in the CNS manifest themselves through alterations in nociceptive thresholds (allodynia) and alterations in pain pathways (physiologic transformation). Finally, in some individuals, definitive brain lesions including stroke and deep white matter lesions emerge (anatomic transformation). Herein we discuss the evidence that migraine may transform and then consider potential mechanisms as well as risk factors. We close with a brief discussion of clinical strategies that arise based on this perspective on migraine.

Abbreviations: BBB = blood–brain barrier; BMI = body mass index; CA = cutaneous allodynia; CDEA = chronic disorder with episodic attacks; CDH = chronic daily headache; CM = chronic migraine; CSD = cortical spreading depression; HFEM = high-frequency episodic migraine; LFEM = low-frequency episodic migraine; MMP = matrix metalloproteinase; NSAID = nonsteroidal anti-inflammatory drug; PAG = periaqueductal gray; PR = prevalence ratio; WMH = white matter hyperintensity.

Disclosure: This study was conducted without financial support. Dr. Marcelo E. Bigal is an employee of Merck Research Laboratories. The authors received research support and are/were on the speaker bureau of AstraZeneca, Merck, OrthoMcneil, GSK, Allergan, NMT, MAP, ENDO, among other companies. None of these activities relate to this article, which is a Views & Reviews.

Received January 24, 2008. Accepted in final form May 29, 2008.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2008 by AAN Enterprises, Inc.