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Printable Handouts
Navigable Slide Index
- Introduction
- Disclosures
- Overview
- The four questions
- Chronification: do we know it when we see it?
- Migraine incidence and prevalence
- Our assumptions about migraine have not changed
- Migraine transformation 20 years ago
- There is a binary distinction between EM and CM
- Is there clinical value in distinguishing EM from CM?
- Migraine disorders are complex!
- Is there a downside of arbitrary stratification?
- Natural history vs. ICHD-3
- Risk factors and chronification
- Chronification
- Risk factors and CM
- What contributes to chronification?
- Symptomatic markers of chronification
- Migraine attacks vs. allodynia
- What changes as the brain chronifies?
- The pathophysiology of chronification: sensitization
- Sensitization
- Hyperexcitability (1)
- Hyperexcitability (2)
- Dysmodulation
- Potential biomarkers
- Serum biomarkers for progression
- CSF biomarker for progression
- The promise of functional MRI
- The promise of functional MRI: across the literature
- Amygdala volumes in CM vs. EM
- Structural network topology in CM
- Study overview
- Results: model interpretation
- Clinical profiles of migraine biotypes
- Summary
- Diagnosis and staging
- Chronification patterns
- What questions do we need to stage migraine?
- Who is the chronifying patient?
- How do we manage chronification? (1)
- How do we manage chronification? (2)
- How do we manage chronification? (3)
- How we fail the chronifying patient
- In conclusion
- An interesting note
- Colleagues, collaborators and co-conspirators
- Thank you for your kind attention
Topics Covered
- Episodic migraine
- Chronic migraine
- Chronification of migraines
- Risk factors of migraines
- Allodynia
- Sensitization
- Hyperexcitability
- Dysmodulation
- Potential biomarkers
- Functional MRI
- Managing chronification
Links
Series:
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Therapeutic Areas:
Talk Citation
Cowan, R.P. (2023, November 30). Phenotyping the migraine patient [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved November 4, 2024, from https://doi.org/10.69645/YMSS6244.Export Citation (RIS)
Publication History
Financial Disclosures
- There are no commercial/financial matters to disclose.
Other Talks in the Series: Toward a Deeper Understanding of Headache and Migraine
Transcript
Please wait while the transcript is being prepared...
0:00
My name is Rob Cowan.
I am a Professor of
Neurology and Neurosciences
at Stanford University.
I'll be talking today
about phenotyping the
migraine patient.
0:14
I have no relevant disclosures
relating to this topic,
but here are my other
activities for reference.
The overview of
phenotyping is actually
0:22
a fairly straightforward issue.
We had no diagnostic criteria
for migraine and
other headache types
until the late 1980s,
when the International
Classification of Headache Disorders
was first defined.
Since then we've had
about three and a half
iterations of that
classification system.
But we still have
an issue in terms
of where to go once we
have identified someone
as having the
phenotype of migraine
and that remains the
elephant in the room.
How do we decide,
given someone has migraine,
what the most appropriate
treatment strategy should be?
How do we monitor for efficacy,
most bothersome symptom
and other measures that seem
to be important to patients
and to our research
in the field.
1:17
Let's start with what I consider
the four basic questions.
First, who are the most
challenging migraine patients?
Who are the patients who have
a diagnosis of migraine,
but are most challenging to us
in figuring out what the
best treatment strategy is?
What is the most important
measure of success?
By that I mean do our
measures of success,
things like decrease in
frequency, severity,
and duration of episodes,
correlate with the single
most important measure
for individual patients.
Multiple studies have
shown that there's
not always a one
to one correlation
between what the doctor
thinks is most important
and what the patient
thinks is most important.
Certainly when do we decide
that management is not working?
When do we decide
if an intervention
has not been successful
and we need to change gears
and how do we make
that determination?
Then finally, what
is chronification?
Chronification is
a term that we're
hearing increasingly,
and that's the patient
who goes from having
a few headaches a
month or a year,
to having headaches that are
increasingly frequent, severe,
with more prominent symptoms
like cutaneous allodynia
and central sensitization.
Why is it that some patients go
from a few headaches a year
to having almost
daily headaches,
while others just stay
low frequency episodic
throughout most of their lives.