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Do Episodic Migraines Always Become Chronic?

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Do Episodic Migraines Always Become Chronic?

If you experience recurring migraines, you’ve likely already realized: managing migraine can be a lifelong journey. As time passes, you may have even noticed changes in your migraine symptoms, or episodes becoming more frequent, more painful, or longer-lasting. 

It’s true that migraine can progress through a spectrum, and its features and frequency might change over time, from episodic (less than 15 attacks per month) to chronic (15 or more per month). But does that change have to happen? Let’s review what leads to chronic migraine, and consider how to minimize these changes and keep you living your best life.

What is Chronic Migraine?

Your migraines are considered chronic if you experience 15 or more headache days a month, 8 of them with additional symptoms like nausea or hypersensitivity to light and smell. For most people with chronic migraine, head pain tends to be more severe than what’s reported with episodic migraine. Chronic episodes also seem to last longer, regardless of medication. 

And there’s no question that the intense nature of chronic migraine can seriously impact an individual’s home and work life, not to mention their wallet. Compared to people with episodic migraine, those with chronic migraine visit primary care providers and headache specialists almost twice as often for their pain, as well as for other issues like non-headache pain, depression, hypertension, and even asthma. 

Does Episodic Migraine Turn into Chronic?

Since migraine is heritable, certain genetic factors make some people more vulnerable to developing chronic migraine than others. In addition, being female, or of Caucasian descent, compounds those genetic risk factors. 

But on a positive note, not every individual with episodic migraine will progress to chronic. In fact, each year, just 2.5% of the episodic population experiences this shift.  

And more good news: many people who already have chronic migraine aren’t fated to live with its symptoms indefinitely. Migraine doesn’t necessarily worsen with age, and people in their later years often report milder, less frequent symptoms. 

Risk Factors for Chronic Migraine

Clinically, episodic and chronic migraine are actually completely different conditions. And the path from episodic to chronic is not necessarily a straight one; it can twist and turn. 

But even if you’re genetically predisposed to chronic migraine, you’re not necessarily destined to have it, unless other risk factors overwhelm the body’s ability to cope and repair itself. Lifestyle factors — depression, poor sleep quality or an underlying sleep disorder, medication overuse, obesity, financial disadvantage — can contribute significantly to the onset of chronic migraine. For example, according to a review, people with chronic migraine had experienced more recent, stressful life events, such as divorce or the loss of a loved one, than people with episodic migraine had. 

Clinically, episodic and chronic migraine are actually completely different conditions. And the path from episodic to chronic is not necessarily a straight one; it can twist and turn. 

Biological Causes

Scientists don’t yet fully understand the underlying mechanisms that cause a progression from episodic to chronic migraine, but they’ve noted a major difference in how people with each type respond to treatment. This suggests that distinct biological mechanisms are at work. 

Some researchers feel that a shift to more frequent, more painful migraines might occur as ongoing inflammation from episodic attacks begins to continually activate the trigeminal nerve (the large cranial nerve believed to be involved in migraine formation), and as brain signals (from spinal cord to thalamus to sensory cortex) are gradually altered.

Also, individuals with chronic migraine tend to use medication — acute treatments like non-steroidal anti-inflammatory drugs (NSAIDs) or migraine-specific medications like triptans — more frequently on a migraine day than people with episodic migraine do. Increased use of acute meds may eventually progress episodic migraine into a chronic state. If you have episodic migraine, carefully monitor your medication intake and discuss it with your doctor, to avoid potentially worsening your headache pain and frequency. 

Preventing Chronic Migraine

For people who already experience chronic migraine, treatments such as topiramate, erenumab, and botox injections have been found effective. And successful preventive treatment is often quite possible as well, thanks to calcitonin gene receptor peptide (CGRP) antagonists like Erenumab and Atogepant. (A wide range of other drug classes — anticonvulsants, beta blockers, antidepressants — are sometimes used to manage migraine symptoms; however, they’re still not proven widely effective in treating chronic migraine.) 

Also showing great promise for people with chronic migraine: emerging non-invasive therapies like neuromodulation devices. These devices deliver electrical or magnetic pulses to specific nerves believed to play a role in migraine formation. 

The final takeaway: Your episodic migraines need not necessarily progress to chronic ones. Careful medication dosing, lifestyle modifications, and stress management tactics like regular exercise can go a long way to keeping your migraines less frequent, less intense, and easier to manage.

And for those who already experience chronic migraine, it can be effectively treated, or potentially prevented, thanks to promising new treatments like anti-CGRP medication and neuromodulation.

Do you experience migraines fairly regularly? No matter what their frequency or intensity, chances are you can do more to improve how you manage them. A DNA-guided treatment program can provide an approach tailored to your genetics that works more quickly to treat or eliminate your migraine. 

The headache specialists at Mable can help guide you through treatment, prevention, and lifestyle changes that could be a great fit for you! Take our quick, easy DNA quiz to find out.

  1. Current Pain and Headache Reports. Katsarava, Zaza, et al. Defining the Differences between Episodic Migraine and Chronic Migraine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258393/
  2. The Journal of Headache and Pain. Andreou, Anna P, and Lars Edvinsson. Mechanisms of Migraine as a Chronic Evolutive Condition. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929435/
  3. Frontiers. Viganò, Alessandro, et al. Treating Chronic Migraine with Neuromodulation: The Role of Neurophysiological Abnormalities and Maladaptive Plasticity. https://www.frontiersin.org/articles/10.3389/fphar.2019.00032/full
  4. NIH/National Library of Medicine. Update of Neuromodulation in Chronic Migraine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8583582/
  5. Mable Website. Qulipta® (Atogepant) Migraine Prevention Medication. https://www.trymable.com/blog/qulipta-atogepan
  6. Mable Website. New Migraine Treatment: Anti-CGRP Therapy and How It Works. https://www.trymable.com/blog/anti-cgrp-treatment-options
  7. Mable Website. Individualized Migraine & Headache Relief Medication. https://www.trymable.com/
  8. Mable DNA Quiz. https://www.trymable.com/quiz/dna

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Updated on
October 6, 2022
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