Editing Migraine (section)

==Prognosis==
"Migraine exists on a continuum of different attack frequencies and associated levels of disability."<ref>{{cite journal | vauthors = Silberstein SD, Lee L, Gandhi K, Fitzgerald T, Bell J, Cohen JM | title = Health care Resource Utilization and Migraine Disability Along the Migraine Continuum Among Patients Treated for Migraine | journal = Headache | volume = 58 | issue = 10 | pages = 1579–1592 | date = November 2018 | pmid = 30375650 | doi = 10.1111/head.13421 | s2cid = 53114546 }}</ref> For those with occasional, episodic migraine, a "proper combination of drugs for prevention and treatment of migraine attacks" can limit the disease's impact on patients' personal and professional lives.<ref name="NINDS">{{cite web | url = https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page | title = Migraine Information Page: Prognosis | archive-url = https://web.archive.org/web/20200610010837/https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page | archive-date=10 June 2020 | work = National Institute for Neurological Disorders and Stroke (NINDS) | publisher = National Institutes of Health (US) }}</ref> But fewer than half of people with migraine seek medical care and more than half go undiagnosed and undertreated.<ref>{{cite web|title=Key facts and figures about migraine|year=2017|url=https://www.migrainetrust.org/about-migraine/migraine-what-is-it/facts-figures/|archive-url=https://web.archive.org/web/20170312001659/https://www.migrainetrust.org/about-migraine/migraine-what-is-it/facts-figures/|archive-date=12 March 2017|website=The Migraine Trust|access-date=13 June 2021|url-status=live}}</ref> "Responsive prevention and treatment of migraine is incredibly important" because evidence shows "an increased sensitivity after each successive attack, eventually leading to chronic daily migraine in some individuals."<ref name="NINDS" /> Repeated migraine results in "reorganization of brain circuitry", causing "profound functional as well as structural changes in the brain."<ref name="Brennan_2018">{{cite journal | vauthors = Brennan KC, Pietrobon D | title = A Systems Neuroscience Approach to Migraine | journal = Neuron | volume = 97 | issue = 5 | pages = 1004–1021 | date = March 2018 | pmid = 29518355 | pmc = 6402597 | doi = 10.1016/j.neuron.2018.01.029 }}</ref> "One of the most important problems in clinical migraine is the progression from an intermittent, self-limited inconvenience to a life-changing disorder of chronic pain, sensory amplification, and autonomic and affective disruption. This progression, sometimes termed chronification in the migraine literature, is common, affecting 3% of migraineurs in a given year, such that 8% of migraineurs have chronic migraine in any given year." Brain imagery reveals that the electrophysiological changes seen during an attack become permanent in people with chronic migraine; "thus, from an electrophysiological point of view, chronic migraine indeed resembles a never-ending migraine attack."<ref name="Brennan_2018" /> Severe migraine ranks in the highest category of disability, according to the World Health Organization, which uses objective metrics to determine disability burden for the authoritative annual ''Global Burden of Disease'' report. The report classifies severe migraine alongside severe depression, active psychosis, quadriplegia, and terminal-stage cancer.<ref>{{cite web | publisher = World Health Organization | date = 2008 | quote = Disability classes for the ''Global Burden of Disease study (table 8) | url = https://apps.who.int/iris/bitstream/handle/10665/43942/9789241563710_eng.pdf | title = The Global Burden of Disease: 2004 Update | archive-url = https://web.archive.org/web/20210613232410/https://apps.who.int/iris/bitstream/handle/10665/43942/9789241563710_eng.pdf | archive-date = 13 June 2021 | page = 33}}</ref>

Migraine with aura appears to be a risk factor for [[ischemic stroke]]<ref name=Stroke2009>{{cite journal | vauthors = Schürks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T | title = Migraine and cardiovascular disease: systematic review and meta-analysis | journal = BMJ | volume = 339 | pages = b3914 | date = October 2009 | pmid = 19861375 | pmc = 2768778 | doi = 10.1136/bmj.b3914 }}</ref> doubling the risk.<ref>{{cite journal | vauthors = Kurth T, Chabriat H, Bousser MG | title = Migraine and stroke: a complex association with clinical implications | journal = The Lancet. Neurology | volume = 11 | issue = 1 | pages = 92–100 | date = January 2012 | pmid = 22172624 | doi = 10.1016/S1474-4422(11)70266-6 | s2cid = 31939284 }}</ref> Being a young adult, being female, using [[hormonal birth control]], and smoking further increases this risk.<ref name=Stroke2009/> There also appears to be an association with [[Vertebral artery dissection|cervical artery dissection]].<ref>{{cite journal | vauthors = Rist PM, Diener HC, Kurth T, Schürks M | title = Migraine, migraine aura, and cervical artery dissection: a systematic review and meta-analysis | journal = Cephalalgia | volume = 31 | issue = 8 | pages = 886–96 | date = June 2011 | pmid = 21511950 | pmc = 3303220 | doi = 10.1177/0333102411401634 }}</ref> Migraine without aura does not appear to be a factor.<ref name=Kurth2010>{{cite journal | vauthors = Kurth T | title = The association of migraine with ischemic stroke | journal = Current Neurology and Neuroscience Reports | volume = 10 | issue = 2 | pages = 133–9 | date = March 2010 | pmid = 20425238 | doi = 10.1007/s11910-010-0098-2 | s2cid = 27227332 }}</ref> The relationship with heart problems is inconclusive with a single study supporting an association.<ref name=Stroke2009/> Migraine does not appear to increase the risk of death from stroke or heart disease.<ref name="Death2011">{{cite journal|vauthors=Schürks M, Rist PM, Shapiro RE, Kurth T|date=September 2011|title=Migraine and mortality: a systematic review and meta-analysis|journal=Cephalalgia|volume=31|issue=12|pages=1301–14|doi=10.1177/0333102411415879|pmc=3175288|pmid=21803936}}</ref> Preventative therapy of migraine in those with migraine with aura may prevent associated strokes.<ref>{{cite journal | vauthors = Weinberger J | title = Stroke and migraine | journal = Current Cardiology Reports | volume = 9 | issue = 1 | pages = 13–9 | date = March 2007 | pmid = 17362679 | doi = 10.1007/s11886-007-0004-y | s2cid = 46681674 }}</ref> People with migraine, particularly women, may develop higher than average numbers of [[white matter]] brain lesions of unclear significance.<ref>{{cite journal | vauthors = Hougaard A, Amin FM, Ashina M | title = Migraine and structural abnormalities in the brain | journal = Current Opinion in Neurology | volume = 27 | issue = 3 | pages = 309–14 | date = June 2014 | pmid = 24751961 | doi = 10.1097/wco.0000000000000086 }}</ref>