Invited Speaker for Scientific Session

Abstract

Migraine is well accepted as a frequently disabling episodic malady, but the concept that the disorder may be associated with progressive and persistent symptoms or brain complications is fraught with controversy and a reluctance of many clinicians to acknowledge to their patients that such issues exist. Nevertheless, literature accrued in recent years speaks to the potential for long-term changes in the phenotypic expression of episodic migraine to a chronic form of headache. Often expressed subclinically, structural brain changes associated with migraine, although uncommon, may range from progressive cellular damage in nociceptive systems, diffuse white and grey matter loss, multifocal white matter lesions, and ischaemic stroke. Accordingly, this presentation will review and critique: • Clinical evidence for shift in phenotype • Neuropsychological testing • Epidemiological data • Cross-sectional prevalence studies • Longitudinal outcomes studies • Impact on comorbid conditions • Comorbid diseases • Mechanisms and markers of progression • Imaging • Markers of inflammation (CRP, metalloproteases) From this evidence, a small but potentially problematic group of migraine patients appear at risk for progression. Migraine may also impact the progression of comorbid diseases such as epilepsy. Duration, frequency and severity of migraine attacks are among risk factors for progression, but future studies need to further elucidate risk factors and markers to identify patients at risk of progression who may require aggressive management. Mechanisms underlying progressive disease are multifactorial but appear linked to the mechanisms and subtype of the attack itself.