Transformed migraines

Sometimes people who experience occasional migraine headaches begin to have them more frequently, perhaps as often as every single day. While this is not common, chronic migraine headaches are very distressing, and even can be disabling, because they are so persistent. These chronic, throbbing, vascular headaches are also known as “transformed” migraines because they are migraine headaches that have changed. The International Headache Society defines them as migraine headaches that have changed from occurring episodically to occurring 15 days or more a month, for at least three months.

How do episodic migraines become transformed migraines?

Many factors may lead to the development of transformed migraine headaches. The typical profile of a person with transformed migraines is someone who developed migraines at a young age, perhaps in their teens. When thinking about the “transformation” it is important to know that:

  • This usually occurs over a long period of time, from months to years
  • This occurs most often when migraine sufferers are in their 20’s or 30’s
  •  More women than men develop transformed migraine headaches
  •  90% of the women who develop transformed migraine headaches have suffered from the “classic” migraine with aura
  • Depression and hypertension are also more common in people who develop transformed migraine headaches

One important theory is that since most of these migraine sufferers have used a great deal of medication, in many situations not as prescribed, perhaps they have developed a tolerance to it or a dependence that gradually leads them to use more and more medication.

The nature of the migraine headaches may also change when becoming transformed. They may be less severe, causing less sensitivity to light and sound, or less frequent nausea. But the headaches can occur daily. A commonly heard statement is “My headaches don’t hurt as much, but they hurt every day.” These less severe headaches are in addition to the normal frequency of severe, “full-blown” migraines, making things even worse.

Are all daily headaches transformed migraine headaches?

It can be hard to make the diagnosis of a transformed migraine headache. Most often, there is no underlying physical cause, and they may easily be confused with medication “rebound” or withdrawal headaches, or even chronic tension headaches. This is when a headache specialist, and perhaps a multidisciplinary team of providers who can look at the patient as a whole, can be extremely helpful.

How to prevent transformed migraines

It is important to treat an escalation in the frequency of migraine headaches very aggressively to prevent them from becoming transformed migraine headaches. Even though it can be frustrating to stick with your treatment plan and provider when you feel so bad, you can hurt yourself by doctor shopping and self-prescribing, or mixing medications on your own. It is easy to slip into the bad habit of taking too much medication, or even using a new medication along with other medications you should have stopped and thrown away. If you make a “drug cocktail” with medicines that were not meant to be used together, add in over-the-counter medications, herbal supplements, or drinks that are high in caffeine, and the stage is set for trouble.

How to treat transformed migraine headaches

It is important to get on top of these headaches early, as chronic migraines can be hard to treat. Sometimes it is necessary to stop taking all medication, which may require hospital admission.

Summary

The best treatment for transformed migraine headaches is prevention. Working closely with your health care provider, being honest and forthright about the treatments you are trying, keeping a good record of your medications and using them as prescribed, is the best way to prevent transformed migraine headaches.

References

Robert, T. (2005). Living Well With Migraine Disease and Headaches. New York: HarperCollins.

Young, W. & Silberstein, S. (2004). Migraine and Other Headaches, New York, NY: AAN Press.