Supplement Article

Episodic and Chronic Migraine Headache: Breaking Down Barriers to Optimal Treatment and Prevention

Richard B. Lipton MD

Richard B. Lipton MD

Department of Psychiatry and Behavioral Sciences, Department of Epidemiology & Population Health, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA

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Stephen D. Silberstein MD

Corresponding Author

Stephen D. Silberstein MD

J, efferson Headache Center, Jefferson Hospital for Neuroscience, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA

Address all correspondence to S.D. Silberstein, Jefferson Headache Center, Jefferson Hospital for Neuroscience, Department of Neurology, Thomas Jefferson University, Suite 8130, 111 South 11th Street, Gibbon Building, Philadelphia, PA 19107, USA.Search for more papers by this author
First published: 06 February 2015
Citations: 216

Conflict of Interest:

Dr. Lipton has the following financial relationships:

Consultant/independent contractor: Allergan, Inc., eNeura, Inc., Alder Biopharmaceuticals, Inc., Novartis, Labrys Biologics, Inc., CoLucid Pharmaceuticals, Inc., Merck & Co, Inc., Johnson & Johnson Services,Inc., Nautilus Neurosciences, Inc., Dr. Reddy's Laboratories Ltd, NuPathe Inc., Zogenix, Inc.

Grant/research support: National Institutes of Health.

Honoraria: Cornell University, American Academy of Neurology, Alder Biopharmaceuticals, Inc., American Headache Society, eNeura, Inc., Montefiore Medical Center, Merck & Co, Inc., Novartis, SAI Partners, Labrys Biologics, Inc., Zogenix, Inc.

Stock shareholder: eNeura, Inc.

Dr. Silberstein has the following financial relationships:

Consultant/advisory panel member: Alder Biopharmaceuticals, Inc., Allergan, Inc., Amgen Inc., Avanir Pharmaceuticals, Inc., eNeura, Inc., ElectroCore Medical, LLC, Labrys Biologics, Inc., Medscape, LLC, Medtronic, Neuralieve Inc., National Institute of Neurological Disorders and Stroke, Pfizer Inc., Teva Pharmaceutical Industries Ltd.

Research support: Allergan, Inc., Amgen, Inc., Cumberland Pharmaceuticals, Inc., ElectroCore Medical, LLC, Labrys Biologics, Inc., Eli Lilly and Company, Merz North America, Troy Healthcare, LLC.

Financial Support: Allergan, Inc.


Migraine is a common disabling primary headache disorder that affects an estimated 36 million Americans. Migraine headaches often occur over many years or over an individual's lifetime. By definition, episodic migraine is characterized by headaches that occur on fewer than 15 days per month. According to the recent International Classification of Headache Disorders (third revision) beta diagnostic criteria, chronic migraine is defined as “headaches on at least 15 days per month for at least 3 months, with the features of migraine on at least 8 days per month.” However, diagnostic criteria distinguishing episodic from chronic migraine continue to evolve. Persons with episodic migraine can remit, not change, or progress to high-frequency episodic or chronic migraine over time. Chronic migraine is associated with a substantially greater personal and societal burden, more frequent comorbidities, and possibly with persistent and progressive brain abnormalities. Many patients are poorly responsive to, or noncompliant with, conventional preventive therapies. The primary goals of migraine treatment include relieving pain, restoring function, and reducing headache frequency; an additional goal may be preventing progression to chronic migraine. Although all migraineurs require abortive treatment, and all patients with chronic migraine require preventive treatment, there are no definitive guidelines delineating which persons with episodic migraine would benefit from preventive therapy. Five US Food and Drug Association strategies are approved for preventing episodic migraine, but only injections with onabotulinumtoxinA are approved for preventing chronic migraine. Identifying persons who require migraine prophylaxis and selecting and initiating the most appropriate treatment strategy may prevent progression from episodic to chronic migraine and alleviate the pain and suffering associated with frequent migraine.