Scientists are trying to work out why attacks become more and more frequent in some people — and how to reverse the process.

Len Barbieri started getting migraine headaches when he was 9 years old, although it was many years before they were labelled as such. The condition ran in his family; both his father and his aunt experienced migraines. As a teenager, Barbieri remembers driving his father to the hospital, where only a shot of morphine could provide relief.

By the age of 16, Barbieri was also taking a prescription opioid for the pain. Unlike his relatives, he didn’t experience neurological disturbances known as aura before the headache, or the sensitivity to light that confined them to darkened rooms. “I just had terrible, terrible headaches,” he says. Often the pain would start on one side of his head, then spread to both sides. Over a wider area, the pain felt more diffuse, but when it concentrated down to just one temple, it felt like he was being stabbed. “I remember miserable days,” he says.

The attacks persisted through university, and became more frequent during his career working in criminal justice — first as a parole officer, then eventually becoming a warden in the state of Connecticut. Eventually he was having two attacks a week, some lasting two or three days, totalling 10–20 headache days a month. Barbieri powered through them, working his way through various prescriptions that provided some relief. The drugs did not stop the cycle — in fact, they might even have increased the frequency and length of his headaches — but Barbieri felt he had no option but to take what little immediate relief they provided. “Otherwise it was unbearable,” he says.

Migraine is estimated to affect more than one billion people, and can vary widely from person to person. However, one notable feature of the condition is that some people see a persistent increase in the frequency of attacks, known as chronification. Every year, about 2.5% of people with episodic migraine, which is defined as fewer than 15 headache days a month, move to chronic migraine, experiencing 15 or more headache days monthly.

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