What is a Transformed Migraine?

A transformed migraine is a migraine condition that enters a chronic state, with the patient experiencing headaches as often as once a day. The onset is usually slow, with a patient having a history of migraines every few months or weeks and gradually experiencing an increase in frequency. As the headaches get closer together, the intensity decreases, and the transformed migraine may be mistaken for tension headaches unless the patient is carefully evaluated.

The reasons a migraine condition evolves into transformed migraine are not well understood. Often the patient has other medical issues and may have developed a tolerance to medications used for pain management. Usually, patients are in their 20s or 30s at the onset of transformed migraine and they often experience a throbbing sensation during the headaches, indicative of vascular involvement.

Also known as chronic migraine, this migraine condition can be debilitating for the patient. While the headaches are usually milder than a typical episodic attack of migraine, patients can experience nausea, vomiting, and low tolerance for light or sound during a headache. It can be difficult to concentrate on work, childcare, and other activities, and the patient may need to spend time in bed resting, as movement can be unpleasant as well.

Options for management of transformed migraine include taking prescription medications to help manage the pain. These medications may need to be changed and adjusted over time as the patient develops a tolerance. Care must also be taken to avoid rebound headaches, where a patient manages an initial headache with medications and vasoconstrictors like caffeine, only to experience another headache when the treatments wear off. Increased dependence on pain management can also make it more difficult to manage migraine pain, as the patient will require more and more medication and could be in danger of complications. Changing the diet can sometimes help, as some foods act as migraine triggers.

When people experience almost daily migraine headaches and are evaluated for transformed migraine, they should describe the symptoms as completely as possible and take note of any special circumstances surrounding their headaches. This can be important for differentiating between different kinds of headaches. The doctor may request a medical imaging study of the brain to evaluate the patient for tumors and other possibilities before offering a diagnosis of transformed migraine. Patients may need to meet with employers to discuss workplace accommodations to help reduce the risk of developing migraines at work and decide how to address headaches when they occur.