Chronic Migraine

Reviewed by: HU Medical Review Board | Last reviewed: October 2020 | Last updated: March 2022

Chronic migraine means a person has headaches 15 or more days per month for more than 3 months, plus migraine symptoms on at least 8 days per month. Those symptoms include nausea, aura, sensitivity to light, sound, and odor.1,2

People living with chronic migraine face significantly more challenges to daily life than people who have migraines less often.

Who gets chronic migraine?

Roughly 2 out of every 100 people worldwide have chronic migraine. Doctors do not know what causes chronic migraine, but they think it may be caused by changes in the brainstem after years of less frequent or episodic migraine. Poorly treated headaches and migraine attacks seems to increase the risk of developing chronic migraine.1

Other risk factors for chronic migraine include:1

  • Frequent use of drugs to abort migraine head pain
  • Obesity
  • Snoring (sleep apnea)
  • Caffeine
  • Untreated depression and anxiety

The stigma of chronic migraine

Several studies show that people with chronic migraine feel more stigma than people with other neurological diseases such as occasional (episodic) migraine, epilepsy, stroke, Alzheimer’s disease, or Parkinson’s disease. Not being able to work was the biggest source of stigma for people with chronic migraine.3,4

One study found that over a 3-month period, people with chronic migraine:5

  • 8.2 percent missed at least 5 days of work
  • 1 in 3 reported at least 5 days of lower productivity at work
  • More than half reported at least 5 days of less ability to take care of household chores
  • 1 in 3 reported missing family activities at least 5 days

Diagnosing chronic migraine

Keeping a migraine diary can help you spot if you are getting more migraine attacks than in the past. Keep track daily of the exact number of days per month you have a headache and any migraine symptoms that may come before or after the head pain.

Your migraine diary will also help your doctor decide if your attacks suggest you have chronic migraine. According to the International Headache Society’s International Classification of Headache Disorders, a person may have chronic migraine if:2

  • They have tension headaches or migraine head pain 15 or more days per month for 3 months or longer, plus migraine symptoms on at least 8 of those days
  • Migraine symptoms include nausea, vomiting, aura, and sensitivity to light, sound, or smells
  • Pain and migraine symptoms get better when treated with a triptan, dihydroergotamine, or ergotamine

Treating chronic migraine

Chronic migraine treatment includes a combination of avoiding triggers, using your migraine drugs correctly, and lifestyle changes.6

Common triggers to avoid

A diary will help you identify your personal migraine triggers. Some common triggers that can be avoided include:

  • Stress
  • Certain foods
  • Caffeine
  • Alcohol
  • Smoking
  • Not sleeping
  • Not eating

However, most people cannot avoid a trigger like the weather.

Using drugs to treat migraine

Your headache doctor should be able to coach you on how the best ways to use your migraine drugs. For example, you want to avoid relying too much on acute migraine drugs since that can cause what is known as medication overuse headache. Acute drugs are taken at the beginning of an attack to reduce its severity.6

With proper management, many people find they can reduce how often they get migraines, how severe the migraines are, and miss out on fewer days of work and fun. Preventive drugs can help reduce how often you have migraines and how severe the attacks are.

Lifestyle changes

Lifestyle changes can also help manage chronic migraine. Some common examples include:6

  • Relaxation techniques and biofeedback to help you reduce stress
  • Physical therapy, acupuncture, or massage to relieve muscle tension
  • Good routines for sleep, meals, and exercise

With treatment, many people with chronic migraine find their attacks become less frequent and revert back to episodic migraine.6

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