Chronic Migraine

The frequency and severity of migraine differs from patient to patient. Episodic migraine is characterized by those with migraine who have up to 14 headache days per month; chronic migraine is characterized by 15 or more headache days per month. Chronic migraine is a severe and debilitating condition affecting around 2% of the population. 

What Causes It?

Up to 3% of people with migraine may undergo migraine chronificationa slow increase in frequency of their migraine until their condition is ultimately deemed chronic. At this level, the burden already placed on a person’s lifestyle by their episodic migraines becomes further magnified and even more difficult to manage.

Fortunately, spontaneous or treatment-induced remission is often possible, with up to 26% of those affected by chronic migraine experiencing remission within 2 years of onset. 

Much research remains to be done, but certain risk factors have been identified that may predispose some individuals to chronic migraine. These risks include anxiety and depression; chronic pain syndromes, such as back pain or post-concussion headache; obesity; and poor sleep patterns. However, it’s so far unknown whether these risk factors cause more frequent migraine or are symptoms of more severe migraine.

In addition, a recent study shows that inadequate treatment of acute migraines increases the chance that the individual will develop chronic migraine, indicating that it's vital to get the acute management of migraines right, as quickly as possible.

What Are the Symptoms?

Episodic and chronic migraine have the same symptoms, including:

  • Throbbing pain or pressure-like pain that is moderate to severe in intensity 
  • Pain on one or both sides of the head
  • Sensitivity to light, sound, and smells
  • Nausea/vomiting
  • Dizziness

The main difference between episodic and chronic migraine is the increased frequency seen with chronic migraine. Another difference: people living with chronic migraine have a greater likelihood of depression, anxiety, and various respiratory and cardiovascular conditions. 

How Is It Diagnosed? 

The International Classification of Headache Disorders is very specific in its definition of chronic migraine. To diagnose chronic migraine in an individual, a specialist will look for migraine to occur on more than 15 migraine days in a month, for at least three months, during which 8 or more days display symptoms of migraine without aura and/or respond to migraine-specific treatment, “occurring in a patient with a lifetime history of at least five prior migraine attacks” not caused by another disorder or by medication overuse.

The physician takes a detailed history on the pattern of the individual’s migraine pain when and how it begins; if it is continuous; where it occurs; how long it lasts; how severe it is; and if particular triggers tend to worsen it as well as other migraine-related symptoms that may accompany the pain. The doctor also takes into consideration any medications, therapies, and treatments, past or current, that the affected person has tried, and reviews their personal and family medical history, including health issues and health-related lifestyle choices.

How Is It Treated?

The treating physician will focus on having the affected individual treat their migraine attack as soon as pain begins, while it is still mild, using a simple painkiller (aspirin, NSAIDs) and slowly increasing the dosage to the maximum tolerated. If headache begins with more severe pain, the doctor may add a prescription medication such as a triptan to the treatment plan for increased effectiveness. 

Treatment of chronic migraine can require particular care if it’s caused by medication overuse. The doctor will supervise a gradual taper of any ineffective medication to avoid triggering withdrawal symptoms and intensifying headache pain.

Is It Preventable?

In most cases of chronic migraine, the treating physician will focus on preventative treatment such as beta-blockers, topiramate, valproate, Botox, or calcitonin gene-related peptide (CGRP) blocking medications.

People affected by episodic migraine can help to prevent it from becoming chronic by keeping a daily headache diary, carefully recording symptoms and modifying risk factors as needed. They should consult their headache specialist if they note any increase in frequency or severity of their headaches. Specialists agree, It is easier to halt and reverse chronic migraine if caught early.

What Causes It?

Up to 3% of people with migraine may undergo migraine chronificationa slow increase in frequency of their migraine until their condition is ultimately deemed chronic. At this level, the burden already placed on a person’s lifestyle by their episodic migraines becomes further magnified and even more difficult to manage.

Fortunately, spontaneous or treatment-induced remission is often possible, with up to 26% of those affected by chronic migraine experiencing remission within 2 years of onset. 

Much research remains to be done, but certain risk factors have been identified that may predispose some individuals to chronic migraine. These risks include anxiety and depression; chronic pain syndromes, such as back pain or post-concussion headache; obesity; and poor sleep patterns. However, it’s so far unknown whether these risk factors cause more frequent migraine or are symptoms of more severe migraine.

In addition, a recent study shows that inadequate treatment of acute migraines increases the chance that the individual will develop chronic migraine, indicating that it's vital to get the acute management of migraines right, as quickly as possible.

What Are the Symptoms?

Episodic and chronic migraine have the same symptoms, including:

  • Throbbing pain or pressure-like pain that is moderate to severe in intensity 
  • Pain on one or both sides of the head
  • Sensitivity to light, sound, and smells
  • Nausea/vomiting
  • Dizziness

The main difference between episodic and chronic migraine is the increased frequency seen with chronic migraine. Another difference: people living with chronic migraine have a greater likelihood of depression, anxiety, and various respiratory and cardiovascular conditions. 

How Is It Diagnosed? 

The International Classification of Headache Disorders is very specific in its definition of chronic migraine. To diagnose chronic migraine in an individual, a specialist will look for migraine to occur on more than 15 migraine days in a month, for at least three months, during which 8 or more days display symptoms of migraine without aura and/or respond to migraine-specific treatment, “occurring in a patient with a lifetime history of at least five prior migraine attacks” not caused by another disorder or by medication overuse.

The physician takes a detailed history on the pattern of the individual’s migraine pain when and how it begins; if it is continuous; where it occurs; how long it lasts; how severe it is; and if particular triggers tend to worsen it as well as other migraine-related symptoms that may accompany the pain. The doctor also takes into consideration any medications, therapies, and treatments, past or current, that the affected person has tried, and reviews their personal and family medical history, including health issues and health-related lifestyle choices.

How Is It Treated?

The treating physician will focus on having the affected individual treat their migraine attack as soon as pain begins, while it is still mild, using a simple painkiller (aspirin, NSAIDs) and slowly increasing the dosage to the maximum tolerated. If headache begins with more severe pain, the doctor may add a prescription medication such as a triptan to the treatment plan for increased effectiveness. 

Treatment of chronic migraine can require particular care if it’s caused by medication overuse. The doctor will supervise a gradual taper of any ineffective medication to avoid triggering withdrawal symptoms and intensifying headache pain.

Is It Preventable?

In most cases of chronic migraine, the treating physician will focus on preventative treatment such as beta-blockers, topiramate, valproate, Botox, or calcitonin gene-related peptide (CGRP) blocking medications.

People affected by episodic migraine can help to prevent it from becoming chronic by keeping a daily headache diary, carefully recording symptoms and modifying risk factors as needed. They should consult their headache specialist if they note any increase in frequency or severity of their headaches. Specialists agree, It is easier to halt and reverse chronic migraine if caught early.

Sources
  1. NIH/National Library of Medicine. The International Classification of Headache Disorders revised criteria for chronic migraine—field testing in a headache specialty clinic https://pubmed.ncbi.nlm.nih.gov/17263770/
  2. NIH/National Library of Medicine. Defining the Differences Between Episodic Migraine and Chronic Migraine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258393/
  3. Pain. Factors associated with the onset and remission of chronic daily headache in a population-based study. http://www.ncbi.nlm.nih.gov/entrez/query.fcgicmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=14581114
  4. The Journal of Headache and Pain. From transformation to chronification of migraine: pathophysiological and clinical aspects. https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-020-01111-8
  5. Neurology. Rates, predictors, and consequences of remission from chronic migraine to episodic migraine. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=21270413
  6. Journal of Neurology Neurosurgery & Psychiatry. Sociodemographic and comorbidity profiles of chronic migraine and episodic migraine sufferers. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=20164501
  7. Nature. Chronic migraine: risk factors, mechanisms, and treatment. https://www.nature.com/articles/nrneurol.2016.93
  8. Neurology. Ineffective acute treatment of episodic migraine is associated with new-onset chronic migraine. https://pubmed.ncbi.nlm.nih.gov/25609757/

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