Episodic migraine and transformed migraine: a comparative study

EPISODIC MIGRAINE AND TRANSFORMED MIGRAINE: A COMPARATIVE STUDY (ABSTRACT)^*. DISSERTATION. SÃO JOSÉ DO RIO PRETO, SP, 2000.

JOSÉ CARLOS BUSTO GALEGO^**

Headache as a daily or near-daily experience, known as chronic daily headache, is part of a heterogeneous group of headaches. Since there are no well definite diagnostic criteria and no longitudinal studies, this headache group is not included in the classification of the International Headache Society. Transformed migraine is one of the most frequent chronic daily headaches, according to several studies.

The purpose of this study was to compare clinical features of episodic and transformed migraine; observing some correlation with depressive symptoms as well as to evaluate the administration of pain relievers used in transformed migraine.

Clinical features of 40 patients with episodic migraine according to the criteria of the International Headache Society Classification and 40 patients with transformed migraine according to the criteria of Silberstein et al. were compared. Beck's Depression Inventory was used to compare the degree of depressive symptoms between those two groups besides a third group of 40 patients (control) with no headache complaint. The criteria of Silberstein et al. were used to evaluate the administration of pain relievers in the transformed migraine group. Patients with some chronic organic disorders were not included in the study.

Women were the majority in the 3 groups: 82.5% in the episodic, 95.0% in the transformed migraine and 92.5% in the control group. At the first examination, the ages were similar in the 3 groups, whereas the initial age for migraine attacks was smaller in the transformed migraine group (p=0.014). The time experience of episodic attacks was similar in the two groups. The headaches were located predominantly in one point of the head in the episodic migraine group, whereas in the transformed in more than one point (p<0.005). The nature of the throbbing pain was the only in the episodic migraine group, whereas this was variable in the transformed. Variation of pain intensity was more frequent in the transformed migraine group (p<0.005). The frequency of less than 2 associated symptoms was more unusual in the episodic migraine (p<0.0005). The presence of some factor that excited and no worsening factor were features of the transformed migraine. The grouping of improvement factors had significant association with episodic migraine (p= 0.004). Nocturnal awakening with headache, aura, and familiar history did not show significant association with the type of migraine. The overuse of pain relievers was observed in 67.5% of the patients of the transformed migraine group. The episodic migraine group showed a higher frequency of moderate depression, and the transformed, a severe depression, when they were analysed qualitatively.

The transformed migraine group showed some clear clinical features from the episodic migraine such as the frequency, location and intensity of the headache pain. The early initial migraine attacks may suggest a further risk to the transformed migraine. Patients with the transformed migraine showed more severe depression symptoms according to the qualitative results, strengthening some possible comorbidity with depression. The overuse of pain relievers was a common habit among patients with transformed migraine.

KEY WORDS: transformed migraine, chronic daily headache, depression, pain relievers overuse.

**Address: Rua Professor Nelson Bento Lutaif 145, 15091-550 São José do Rio Preto SP, Brasil.

*

Migrânea episódica e migrânea transformada: análise comparativa (Resumo). Dissertação de Mestrado. Faculdade de Medicina de São José do Rio Preto (Área: Biologia Médica). Orientadores: José Paulo Cipullo e Waldir Antonio Tognola.

Publication Dates

• Publication in this collection
  05 Oct 2001
• Date of issue
  Sept 2001