Differences between chronic migraine with and without medication overuse

Dear Editor:

I read with great interest the outstanding article by Rojo et al.¹ analysing the differences between patients with chronic migraine (CM) with and without medication overuse (MO). According to this study, only 57% of these patients had received preventive treatment with the most frequent type being antidepressants; most patients had received only one type of preventive treatment. These findings should encourage self-criticism among general practitioners and neurologists alike regarding the way we manage migraine. This entity constitutes the main reason for neurology consultations in Spain, and it has been ranked eighth by the WHO in terms of impact on activities of daily living.²

Except for longer progression times, Rojo et al. found no differences between these 2 subgroups of patients with CM. This suggests that: (1) CM with and without MO are not separate entities, and (2) in most cases, MO is the consequence of CM, rather than the cause. Departing from the conventional wisdom that the vast majority of patients with CM meet criteria for MO, the above study reports that just over half of the patients with CM (258 out of 434, that is, 59.5%, not 72.2% as cited in the abstract [a considerable percentage by any standards]) met the criteria for MO, confirming once more that MO is not a necessary condition for migraine chronification.

Conflicts of interest

The author has no conflicts of interest to declare.