Risk Factors for Migraines
The primary risk factors for migraines include female sex, high headache frequency, inadequate treatment, medication overuse, and comorbidities such as depression, anxiety, and obesity. 1
Non-Modifiable Risk Factors
- Female sex is a significant risk factor for migraine progression, with women experiencing higher rates of both episodic and chronic migraine 1, 2
- Low socioeconomic status and education level are associated with increased risk of chronic migraine development 2
- Age can influence migraine presentation, with peak prevalence occurring around age 40 1
Modifiable Risk Factors
Headache-Related Factors
- High headache frequency is one of the strongest predictors of progression from episodic to chronic migraine 1, 3
- Inadequate acute treatment of migraine attacks increases risk of chronification 4
- Medication overuse, particularly frequent use of acute headache medications, significantly increases risk of transformation to chronic migraine 1
- Cutaneous allodynia during migraine attacks is associated with increased risk of progression 4
Lifestyle and Environmental Factors
- Caffeine overuse is a significant risk factor for migraine progression, with both high consumption and withdrawal potentially triggering attacks 4, 5
- Obesity increases risk of transformation from episodic to chronic migraine and should be addressed in clinical evaluation 1, 6
- Poor sleep quality and sleep disorders contribute to migraine progression 1, 4
- Physical inactivity is associated with increased risk of migraine progression 4
- Stress and stressful life events can trigger migraines and contribute to chronification 6
Comorbidities
- Depression and anxiety are strongly associated with migraine progression, with 2-3 times higher prevalence in chronic versus episodic migraine 1, 2
- Other chronic pain conditions, particularly neck and lower back pain, are more common in people with chronic migraine 1
- Sleep disorders, including sleep apnea and snoring, increase risk of migraine progression 2, 5
- Metabolic disorders contribute to migraine progression 4
- Respiratory conditions are associated with increased risk of migraine progression 4
Clinical Implications
- Early identification of patients with modifiable risk factors is crucial for preventing progression to chronic migraine 1
- Education about modifiable risk factors should be provided to patients with migraine so they can make appropriate lifestyle changes 1
- Management of comorbidities, particularly depression, anxiety, and sleep disorders, can improve migraine outcomes 1
- Medication management should include education about the risk of medication overuse headache with frequent use of acute medications 1
- Referral to specialist care is typically necessary when chronic migraine develops, as management becomes more challenging 1
Prevention Strategies
- Limit acute medication use to avoid medication overuse headache, generally keeping use to no more than twice weekly 7
- Maintain healthy weight through appropriate diet and exercise 6, 5
- Establish regular sleep patterns to improve sleep quality 7
- Use headache diaries to identify and avoid personal triggers 7
- Consider preventive therapy when patients experience two or more disabling migraine attacks per month 7
- Treat psychiatric comorbidities such as depression and anxiety 5
- Investigate and address sleep problems including sleep apnea and snoring 5
By identifying and addressing these risk factors, clinicians can help prevent the progression from episodic to chronic migraine and reduce the associated disability and burden on patients' quality of life.