Jefferson Journal of Psychiatry


Transformed migraine is one of the subtypes of chronic daily headache (CDH), and is similar to chronic migraine, described in the new International Headache Society (IHS) classification 2004. The term CDH refers to the Headache disorders experienced 15 or more days a month and includes headaches associated with medication overuse. CDH can be divided into primary and secondary varieties. Primary CDH is not related to a structural or systemic illness. It includes diseases such as Transformed migraine (TM). Chronic tension-type headache (CTTH), new daily persistent headache (NDPH), and hemicrania continua (HC). Secondary CDH has an identifiable underlying cause, including post-traumatic headache, cervical spine disorders, vascular disorders, nonvascular intracranial disorders and headaches associated with temporomandibular joint disorders, sinus infections, chronic meningitis, low and high intracranial pressure. In this study we have adopted the 1996 definition of TM proposed by Silberstein and Lipton in preference to the new discredited 2004 IHS criteria for chronic migraine.

The association between migraine and psychiatric disorders has long been established. Several clinic-based and population-based studies have discussed the relationship. However psychiatric comorbidity in transformed migraine has seldom been discussed, and the effect on overall outcome has not been examined . Population based studies have shown that 4% to 5% of the general population has primary CDH. Transformed migraine is the major cause of CDH and is associated with poor quality of life and greater medical and social expenses compared to episodic migraine. CDH is most commonly transformed Migraine and is accompanied by high anxiety levels in most patients and with hysterical traits in some. These patients frequently have a coexisting depressive disorder. The purpose of this study is to characterize psychiatric disorders accompanying TM in a tertiary headache center and to examine their impact on outcome.

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