Kronična migrena kao socioekonomski problem današnjice

Chronic migraine (CM) is a disabling primary headache with the prevalence in the world between 0.9 to 5.1%. It is defined by ICHD-3 criteria as headache that lasts 15 or more days per month for at least 3 months while an 8 days headache per month fulfills the criteria for migraine. CM is typically a progressive episodic migraine (EM), ranging 2.5 – 3 % per year, with a slowly increase in headache frequency and migraine associated symptoms (such as nausea, vomiting, photophobia, phonophobia). There are several risk factors that increase the risk of transformation in CM. One of them is the excessive use of medication, which initiated the discussion regarding the causal or consequential association with CM or with chronic daily headache (CDH). It is believed that CM is, among the four types of CDH, the most debilitating type of long duration CDH (the duration of seizures ≥4 hours), and also a most common form of CDH. Compared with episodic migraine, patients with CM have a significantly lower productivity and more frequent absences from work, school, social activities, and generally reduced quality of life. Also, compared to EM, CM patients visit physicians more often, either due to primary disease, or because of numerous comorbidities. It is estimated that the total cost is four times higher than in patients with EM. Pathophysiologically, frequent headache attacks induce pain modulation system and anatomical damage. As the frequency of headaches rises, the recovery of neurological functions between headache episodes becomes less sufficient. Unfortunately, CM is often an undiagnosed and untreated disorder. In therapy, multidisciplinary approach is essential. In addition to the mandatory prophylactic treatment for reducing migraine attacks, it is necessary to decrease risk factors and comorbidities and also to limit the intake of acute symptomatic drugs. ----- The aim of this paper is to emphasize the importance of socioeconomic aspect of CM through the comparison with EM, underlining the importance of risk factors in transformation into the CM. Also, this paper will present an overview of the changes in classification and nomenclature and give a review of the pathophysiological changes, diagnosis and treatment of CM, based on the most recent evidences.