Clinical presentation of transformed migraine: possible differences among male and female patients

Chronic daily headache (CDH) represents a group of non-paroxysmal headache disorders that occur on a daily or near-daily basis, for longer than 6 mont hs. Even though it is a common problem, affecting 30-70% of the patients at tending specialized headache clinics, it is not a well-defined and classifi ed disorder, resulting in controversies regarding its description and appro ach. The aim of this study was to evaluate the clinical presentation of CDH due to transformed migraine and possibly compare the differences among mal e and female patients. Two hundred and seventy-one patients, 217 women and 54 men, ages 16-83 (mean 37.5 years for women and 41.4 for men), fulfilling the proposed criteria for transformed migraine and selected from a group o f 300 consecutive CDH patients attending a subspecialty headache centre, we re studied retrospectively. The most observed clinical presentation was pre ssure or tightening, bilateral fronto-temporal, moderate non-continuous hea dache, with a progressive onset. The association with nausea and phonophobi a was demonstrated in 60% and 32% of the patients, respectively. The associ ation with photophobia (29.6% male, 44.2% female, P = 0.05) sleep (77.7% ma le, 49.8% female, P = 0.0002) and emotional (87% male, 64.1% female, P = 0. 001) disturbances, as well as the occurrence of intermittent full-blown mig raine attacks (81.5% male, 95.4% female, P=0.001) was significantly differe nt among male and female patients. Overuse of symptomatic medications (SM) was observed in 87% of the male and in 83.8% of the female patients, with a significant difference concerning the use of more than one type of SM (mal e 68% compared with female 91.7%; P=0.006). We concluded that TM patients h ave a clinical presentation compatible with previous descriptions but sugge sting, even though limited by the restricted number of male patients, diffe rent aspects among male and female patients.