Hormonal, metabolic, and stress-related clinical differences between episodic and chronic Migraine: insights for diagnostic and therapeutic approaches

Abstract

Migraine, a common neurological disorder, is categorized into episodic (EM) and chronic (CM) forms. Understanding their hormonal and metabolic differences can enhance insights into migraine pathophysiology and guide clinical approaches. Objective To explore hormonal and metabolic imbalances in EM and CM patients and identify key factors contributing to migraine chronicity. Methods This retrospective, cross-sectional study included 500 patients with migraine (318 EM and 182 CM). Data were retrospectively extracted from pre-existing clinical records, structured intake forms, physician examination notes, questionnaire-based assessments, and available laboratory results to evaluate demographic, clinical, metabolic, stress-related, mental health-related, and comorbidity variables. Results CM patients were older (46.28 vs. 43.13 years, p = 0.002) and had more frequent severe attacks (15 vs. 8/month) and mild attacks (12 vs. 6/month) ( p < 0.001). CM patients exhibited higher rates of anaemia (34.9% vs. 25.7%, p = 0.035), asthma (12.8% vs. 7.3%, p = 0.046), and sleep apnea (4.7% vs. 1.3%, p = 0.034). Fibromyalgia-related symptoms were common in both groups (82.1% in CM vs. 78.2% in EM), while the number of fibromyalgia tender points was higher in CM than in EM patients (median 8 vs. 6). Ferritin levels were lower in CM but not significantly so ( p = 0.139). Suicidal thoughts and feelings of helplessness were more common in CM ( p = 0.016, p = 0.002). CM patients used Botox more often but with lower efficacy and engaged in more cognitive behavioural therapy ( p = 0.002). Conclusion CM was associated with more severe symptoms, higher comorbidity burden, more widespread pain features, and distinct metabolic and stress-related profiles compared with EM. These findings support the early recognition of clinical and comorbid factors associated with the chronic migraine phenotype. CM had more depressive features and fibromyalgia tender points. CM exhibited higher rates of anaemia, asthma, and sleep apnea compared to EM. Cranial sensitivity was higher in EM, and allodynia was more common in CM. Early treatment of EM may prevent its progression to chronic migraine and improve overall health.