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August 2015; 5 (4) Clinical and Ethical Challenges

Taking the headache out of migraine

David Borsook, David W. Dodick
First published August 6, 2015, DOI: https://doi.org/10.1212/CPJ.0000000000000171
David Borsook
Center for Pain and the Brain (DB), Boston Children's and Massachusetts General Hospitals, Harvard Medical School; Department of Anesthesia, Critical Care and Pain Medicine (DB), Boston Children's Hospital; and Department of Neurology (DWD), Mayo Clinic, Phoenix, AZ.
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David W. Dodick
Center for Pain and the Brain (DB), Boston Children's and Massachusetts General Hospitals, Harvard Medical School; Department of Anesthesia, Critical Care and Pain Medicine (DB), Boston Children's Hospital; and Department of Neurology (DWD), Mayo Clinic, Phoenix, AZ.
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Citation
Taking the headache out of migraine
David Borsook, David W. Dodick
Neurol Clin Pract Aug 2015, 5 (4) 317-325; DOI: 10.1212/CPJ.0000000000000171

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Summary

Migraine is a disease that contributes to major disability. Perhaps because migraine attacks are not immediately life-threatening per se and individuals return to a “normal” state between attacks, it is not taken seriously. However, migraine is associated with a number of comorbidities, including psychiatric disease, stroke, and other chronic pain disorders. Current acute treatments for episodic migraine are relatively effective, but preventive treatments for episodic and chronic migraine are far less so. Recent functional imaging studies have shown that the disease affects brain function and structure (either as a result of its genetic predisposition or as a result of repeated attacks). The current evidence in the pain field is that changes observed in brain function and structure may be reversible, adding credence to the notion that treating the disease aggressively and early may be beneficial to patients. Here we suggest a change in our approach to a disease that is currently not treated with the urgency that it deserves given its global prevalence, disease burden, and effects on brain function.

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  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • © 2015 American Academy of Neurology
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