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Will My Chronic Migraine Ever Become Episodic Again?

Please note, since the publication of this article, the guidelines for migraine diagnosis have been updated. For information on the most current, ICHD-III, guidelines please click here.

Chronic Migraineurs often mistakenly believe that they’ll always suffer debilitating Migraine and headache pain more days than not for the rest of their lives, yet this is very often untrue. With good treatment, time and work, chronic Migraineurs will often be able to revert back to episodic status again.

Migraine is a genetic neurologic disease. Chronic Migraine is a complication of Migraine disease that is often misunderstood by patients, usually because the doctors who diagnose and treat them don’t understand the process themselves.

What is chronic Migraine?

Chronic Migraine is not a variant of Migraine disease. A variant (a specific type, often with specific genes guiding them) cannot be changed, however a complication sometimes can be changed. Just as a chronic Migraineur didn’t start out life in a chronic state, they may not necessarily stay chronic. This is good news for chronic Migraineurs!

Sometimes Migraineurs are surprised at exactly what chronic Migraine is. In a nutshell:

  • When the Migraineur has fewer painful days (or days with an attack, which may be without pain) than days spent feeling *normal*, we label that person as an episodic Migraineur. Their heads are free of attacks and pain more days than not.
  • When a Migraineur has more painful days (or days with an attack, which may be without pain) than days spent feeling *normal*, the ICHD-II says that they have transformed or become chronic. They experience head pain and attacks more days than they feel good.

Doctors are aware that there’s a single day that separates a diagnosis of episodic Migraine vs. chronic Migraine, and they’re currently working on a better way to diagnose patients. We suspect chronification has physiological effects in the brain, but we can’t test yet to see if chronification has occurred. Doctors use the ICHD-II definition and criteria to *best guess* which patients are in this situation. It’s certainly not a perfect scenario, but right now it’s the best we have.

How did transformation occur?

Transformation from episodic Migraine to chronic Migraine is so easy, it occurs before the patient and often their doctor is even aware it’s happened. Often it is by journaling their Migraines that patients and their doctors discover how serious the situation has become.

There are many avoidable and unavoidable things that may lead to the transformation of episodic Migraine to a chronic status, but it’s thought that one of the most frequent, avoidable contributors to transformation is the result of unknowledgeable physicians prescribing pain medicines for their patients instead of abortives which stop the Migraine process itself: Medication Overuse Headache (MOH).

Because pain and pain medicines can actually physiologically change how our central nervous systems are wired and function, it is important to treat the root of the problem — Migraine attacks – not just the symptom. Comorbidities which are not well understood or frequently misdiagnosed such as thyroid dysfunction, blood sugar problems, fluctuating hormones or traumatic brain injury can exacerbate Migraines and lead toward chronification. Missing the identification of a frequent trigger may even result in transformation, because the patient is unable to avoid the Migraine process for so long that it causes brain changes that result in chronification.

There are many reasons why an episodic Migraineur may become chronic, but our goal is always to turn that around and help the chronic patient become episodic again, so they can once again become active participants in their lives.

How do I become episodic again?

The transformation from chronic to episodic actually happens with reasonably frequency. Fortunately, one of the reasons we don’t hear about it is that when a patient gets their life back, they often choose to celebrate it by getting involved in the things they love again and choose to try to forget their chronic experience.

  • For those who aren’t taking an oral preventive that helps them, that’s almost always one of the first courses of action and are used in concert with abortive and rescue medicines. Some of these therapies are FDA approved, however most of them are not approved for Migraine prevention. That doesn’t mean they don’t work, but it does mean that the research wasn’t done to prove their effectiveness in Migraineurs. Migraine prevention is a “happy side effect” of these drugs approved for other uses.
  • Fortunately we now have another preventive therapy that seems to work reasonably well for patients who have tried other preventives. OnabotulinumtoxinA (Botox) injections are a more precise, targeted therapy and have been reported to help chronic Migraineurs revert to episodic Migraine patterns again… when done by a trained and skilled physician. Some patients on onabotulinumtoxinA are eventually able to stop or reduce their injections, while others will stay on them indefinitely. Many patients utilize onabotulinumtoxinA in concert with other preventives for optimized Migraine management.
  • Nerve blocks can be useful to help *reset* the central nervous system and revert some chronics to episodic patterns again. These often need to be done repeatedly and multiple injections into multiple locations simultaneously to be effective, but they are worth a try for many patients. The addition of steroids into the anesthetic has not been shown to be helpful for Migraineurs and is discouraged because of potential side effects which may range from mild to serious.
  • There are surgeries that are not FDA approved, but may be helpful for a specific subset of patients when performed by skilled and trained surgeons. Even on their best day, these surgeries do not eliminate or *cure* Migraine despite some claims. They may help with some triggers and symptoms however.
  • Transcranial Magnetic Stimulation is another option we may have up our sleeves, when the FDA gets around to approval. Until then, it is available in Europe, but not here in the United States.

I’ve reverted to episodic again — now what?

If you are on a preventive regimen and you get better, DO NOT STOP IT. This mistake happens frequently and the Migraineurs who try it unsuccessfully are horrified to learn that once stopped, a preventive may not work as well — or at all — when tried again. Sometimes these therapies can eventually be slowly reduced with positive results, but this is better done with the help of your physician and only after a relatively long stretch out of the chronic category. Remember that the brain physically changed when you became chronic. That didn’t happen overnight, and changing it back again will take real time and perseverance.

Sometimes some of the physiologic central nervous system changes that have occurred are permanent. Chronics may never be able to successfully get off their medicines and treatments, even after they have reverted back to an episodic pattern. Their health care partners, management, medicines and treatments are their lifelines.

Take-away points

We know that chronic Migraineurs are more likely to be disabled, suffer comorbid conditions that are difficult to treat, and choose to end their lives. The most important thing I hope chronics will get from this article is that there is hope for them. For us. Being chronic today doesn’t have to be the end of our story…

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Steph Nidd
    7 years ago

    I can relate so much to this article. I’ve lost count the amount of times my medication has been stopped by my doctors even though I’ve only been on the oral preventatives for a month and thus I go back into being a chronic Migraineurs.

    Now that my prescriptions are on repeat this article gives me hope that I can get my life back to normal again and the hope I can go back to university in the near future.

  • Teri-Robert
    7 years ago

    You’re so right when you say, “Being chronic today doesn’t have to be the end of our story…” In 2000, I was spending five or six days a week in bed, all day, with horrid Migraines. By working with a Migraine specialist, I saw so much progress that I was able to get back to episodic averaging no more than one Migraine a month.

    Although I always knew that my preventive regimen wouldn’t work that well forever, it still broke my heart when my Migraines became chronic again about 18 months ago.

    Thankfully, my specialist and I were able to finally start seeing results with a new treatment regimen in the last month or so, and I’m nearly back to episodic status again.

    It takes more time and patience than we often think we possess, but reverting to episodic can and does happen, as does becoming chronic again. We have to be determined, take charge or our health, and work as partners with our doctors to continue working toward the best treatment regimen for us.

  • body
    7 years ago

    ‘Yup!” 🙂

  • body
    7 years ago

    Hi Ellen. I am living proof that chronic migraine can be reversed to episodic. No “miracle pill or magic cure”. Just like you say, a lot of hard work, time, patience and perseverance.

  • Ellen Schnakenberg author
    7 years ago

    Thank you for your comment and mentioning your own experience! Words are one thing, but patients who have experienced this are tough to deny 🙂

  • mikepowe11
    7 years ago


    Thanks, I always enjoy reading your posts. I have a friend who is a psychiatrist and uses Trans-Cranial Magnetic stimulation to treat clnical depression. I’m thinking it must be FDA approved for that use? I wonder if those physicians could use their device “off label” to treat migraine?

  • Ellen Schnakenberg author
    7 years ago

    mikepowe11 – That is a really good question! I have heard of this usage, however I am not sure if there are any differences between the type of stimulation for Migraine vs. the type used for depression. That might be worth a whole blog post! Let’s see what we can do…

  • caryd26
    7 years ago

    I wish I could “like” your “tight-rope walker” comment below Ellen. I agree as for me I’m walking the line more and more these days. But today’s a good day! Thanks for your efforts, research and explanations; they’re tremendously helpful.

  • Ellen Schnakenberg author
    7 years ago

    You’re welcome CaryD 🙂

  • thomas51
    7 years ago

    It may help people to know that there is not only nerve decompression surgery (USA) but South African surgeon Elliot Shevel legates the extracranial superficial arteries, in my view – a layman – maywell have better efficacy if . The reason is because there are many places where the trigeminal nerve could be compressed by muscles where as – more often than not – the dilating vessels during an attack can be compressed to momentarily stop the pain and pin point the vessel(s) plus you can do this yourself to ascertain the possible efficacy of such surgery. The problem is cost – you have to be moderately wealthy. I think it a failure that our NHS and NICE in the UK have not done research into surgery for migraine, it is a minor operation and given the known issues with painkillers and triptans ascertaining the true efficacy of these surgeries would be logical. The problem with botox is that it can’t be good to keep on putting a deadly toxin into the body plus most people can’t afford the ongoing cost, they are seriously disabled and can’t work in a financially meaningful way.

    It is not only that pain killers have caused chronic migraine but triptans also cause rebound migraine and more importantly exacerbate fluctuations in blood pressure – by going from vasodilation to vasoconstriction – and hence in my view – make stroke more likely. Please see the work of Professor Peter Rothwell of Oxford University for his work on the link to BP fluctuations and stroke.

    I’m fortunate enough to only have my corrugator and temporalis muscles to relax for my temporal migraine; if I had the problem at the top/back of my head and my neck muscles – almost impossible to keep relaxed – were involved, for sure I would seriously think about legation surgery.

    It was an absolute revelation to me to find that if I just changed the way I washed my face – very carfully applying and removing soap to stop my corrugator muscle contracting – that this would stop a good 60% of my migraines and then by waring an NTI splint, this would again improve my migraine profile. Unfortunately there is nothing I can do about the problem from odours – usually perfume – the nasal cavity is innervated by the trigeminal nerve – this has kept me off public transport for decades.

  • Ellen Schnakenberg author
    7 years ago

    Hi Thomas – You’ll notice the link I included in the post re: surgical approaches for chronic patients. I hope you get a chance to read it as it does discuss several other options, often carried out by pain management specialists, which do have some record of effectiveness for some patients.

    I agree with you that it is prudent that we should be looking at these surgical procedures as potential treatments for chronics! Part of the problem I see is that there is such stigma attached to Migraine and other headache disorders, that these conditions aren’t taken as seriously as they affect the patients who live with them on a daily basis. Only when the disability and pain experienced by these patients is taken seriously will we begin to see larger steps toward advancing treatments of all types for patients.

    That said, I REALLY want patients to exhaust other *temporary* avenues to help their Migraines before resorting to a surgery from which you cannot go back. As a patient who has suffered from a near fatal medical mistake, I know all too well that complications arise and things happen with procedures too – sometimes death. And the fact is that we don’t even know yet how effective these surgical interventions might be! Patients tend to think of a surgical approach to Migraine as something akin to appendicitis surgery – we have a bad appendix, so we remove it and remove the problem. We are cured – right? Hmmm, not so fast. There is no magical Migraine treatment. Not yet anyway.

    Successful patients keep open minds and have honest and open discussions with their doctors. They make informed and wise choices, keeping in mind that ALL treatments come with warnings, contraindications and side effects – that’s all treatments. They remember that what is best for one, may epic-fail on another. They have patience and determination. They are strong, and have positive attitudes. They accept the tiniest of steps forward with a smile knowing they are headed in the right direction. They remember that it may take a combination of several treatment modalities to get the help they need and they don’t get hung up on single treatments.

    And sometimes, they discover that thinking outside the proverbial box is a good thing too.

    As to putting toxin into our bodies repeatedly, everything is toxic to our bodies if given in inappropriately. Even water and oxygen. Do I want to put toxin in me? No way. But I don’t like chemicals/medicines, cutting chunks of my body out, or sticking needles into my body either. The fact is, when faced with a medical condition like chronic Migraine, we have a choice – do nothing, or treat. Whatever we do to treat them is going to affect our bodies in some way, or it wouldn’t help us. What we hope is that effect is more positive than negative.

    Those with chronic medical conditions live the life of a tight-rope walker…

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