One in 10 Americans experiences migraine headaches, which can be incapacitating. But there may be a light on the other side of your blackout curtains. Currently, doctors diagnose migraine based on patient description and treat the headaches based on frequency—episodic or chronic (more than 15 days per month). Treatment decisions are “worse than trial and error,” clinical professor of neurology Robert Cowan told Stanford Medicine. “It’s darts in the dark.” What’s more, guidelines recommend preventative, daily medication only for people with chronic migraine. But including severity may improve treatment options. In the largest study to date to categorize migraine patients, Cowan and data analyst Jaiashre Sridhar used functional MRI data to identify two biological subtypes. One group of patients had more severe headaches—they tended to last longer and caused more bothersome symptoms (nausea, noise sensitivity, etc.). But those patients were no more likely to have chronic migraine than those with less severe headaches. Cowan believes many episodic migraine patients could benefit from preventative treatment. He’s now pursuing criteria to help clinicians determine which subtype of migraine their patients experience.
Summer Moore Batte, ’99, is the deputy and digital editor of Stanford. Email her at summerm@stanford.edu.
