When I started to deal with headaches, back in the '80s, chronic headaches were the Cinderella of Headache Centers, they were not even formally recognized by the international classification. They were a hodgepodge in which it was difficult to orientate oneself, and gave, to the few daredevils who tried to deal with them, both from the clinical and the scientific point of view, scarce satisfaction. Female patients (I say female patients because 80-90% of the patients belonged to the female gender) were middle-aged women, "doped up" with analgesics and strong psychiatric comorbidity. They were hospitalised for detoxification (in the good old days when there were no DRG) but, after a temporary improvement, often relapsed back into the "habit”.
Since then much has been done: very slowly, despite numerous and tenacious resistance, the first concept of chronic daily headache was formulated and then that of chronic migraine (up to twenty years ago speaking of chronic migraine was an oxymoron, since the migraine disease was episodic by definition). Numerous epidemiological studies have shed light on the dimension of the "chronic migraine" problem (about 2% of the general population is affected) and, most importantly, have illuminated the abyss of suffering that these unfortunate patients have to endure: the renunciation of the joys a of social and family life because even just a slight deviation from the daily routine can be the detonator of a dreadful attack. At times, these patients are even forced to abandon one’s occupation or, at least, the demotion to lesser "demanding" occupations on the physical and emotional level. Excessive use of symptomatic drugs, which nearly all chronic migraine patients are subjected to, on the other hand also imposes its burden of side effects and even serious health risks. Moreover, if much progress has been made in the last twenty years regarding chronic migraine, beginning with its diagnostic criteria definition, very little light has been shed on the longstanding issue of a causal relationship between the "excessive" use of medication and headache chronicification. What was born first, the "abuse" of drugs chicken or the headache egg? Personally, I am convinced that in most cases the migraine becomes chronic for reasons independent from the immoderate use of drugs and that, when the headache becomes daily, the daily use of symptomatic drugs represents a perfectly rational response, but this discussion will take us in another direction…
I am convinced that today, chronic headaches, and chronic migraine in particular, with or without "abuse", should be the core business of Headache Centers. Migraine in general, with its overflowing prevalence (at least 12-15% of the population) cannot, and should not in most cases, be treated at Headache Centers, that can handle only a small share of the cases, but should be the prerogative of trained general practitioners. The Headaches centers should mainly deal with chronic headaches, and above all chronic migraine because they are the most complex cases, those that the general practitioner cannot solve and require specialist skills and a multidisciplinary approach. Chronic migraine represents a great opportunity and a great challenge for headache specialists today: it is the headache that carries the greatest burden of disability, one that gives us more satisfaction when we manage to win the difficult battle, but also the one that today still has many hidden aspects. In light of the new therapies that can be used to counter them, botulinum toxin today, CGRP antagonists tomorrow, it is essential to increase efforts to acquire more knowledge.
It is in this context that the initiative of our Association, with the newly formed section of “Independent Research”, independent of vested interests of any origin. The questionnaire on chronic migraine, accessible with a password distributed by the Associations, aims to be a valuable database that will help us understand the characteristics of the disease in the Italian reality, from demographic variables to those concerning duration and severity of migraine, risk factors and attempted treatments. The database will also serve as a stimulus for other studies of various types that may be proposed by SISC Members, who will, of course maintain ownership and have continuous access to their data.
I therefore urge all SISC Members to input numerous medical records: if participation is massive we can build a database of unique proportions, which will be able to provide scientifically relevant data.