If you suffer from migraines, one of the things your healthcare provider will determine is whether the condition is chronic. Chronic migraines are not uncommon and, in many cases, started as episodic migraines. 

Migraines are reported by about 12% of the global population. In 2013, the WHO found it the sixth highest cause of years lost due to disability. In the US, between three and five percent of the population reports suffering from migraines. Of those suffering episodic migraines, around three percent will transition to chronic migraine status annually.

Physicians separate migraine attacks into one of four categories.

• No migraine
• Low-frequency episodic migraine
• High-frequency episodic migraine
• Chronic migraines

Low-frequency denotes fewer than 10 headache days per month, while high-frequency indicates 10 to 14 headache days per month. 

Migraines are considered chronic if an individual has 15 or more headache days per month over three months.

Defining and Diagnosing Chronic Migraine

The International Headache Society defines chronic migraines as migraines occurring on 15 or more days per month over three months. However, at least eight days a month must feature migraines (as opposed to headaches).

To diagnose chronic migraines, the doctor must determine the exact number of days you experience a headache of any kind per month. For this, the patient keeps a daily headache diary. 

Sometimes people only report severe headaches, such as those that keep them from their daily routine or for which they take medication. However, it is essential to keep track of any headache, no matter the severity, to provide an accurate diagnosis.

The doctor performs a careful assessment to exclude other potential causes of frequent headaches, like secondary headaches from an underlying disease or condition, or whether they are another form of chronic daily headache such as tension headaches, hemicrania continua, or a new daily persistent headache.

If you go weeks or months between migraine attacks, the migraines affect you fewer than 15 days a month, and the headaches typically last fewer than 24 hours, then you probably have regular or episodic migraines. 

A regular migraine can last up to 38.8 hours without treatment or over 12 hours without. The headaches are typically unilateral (felt on one side of the head), pulsing, or throbbing. You may feel nausea, vomit, or become sensitive to light or sound.

Common triggers for an episodic or regular migraine include stress, menstruation, and weather changes. 

Chronic migraines have the same triggers, but you feel head pain 15 or more days a month for at least three months. Also, the migraine symptoms worsen for more than four hours at a time. The duration is also significantly longer, with chronic migraines lasting an average of 65 hours without treatment and 24 with treatment.

Risk Factors and Symptoms

Several risk factors make you susceptible to migraines, including:

• Depression 
• Anxiety 
• Obesity 
• Asthma 
• Snoring 
• Stressful life events 
• Head or neck injuries
• Persistent, frequent nausea
• Acute medication overuse

Chronic migraine often comes with a comorbidity (a secondary condition) that makes you more likely to suffer migraines and complicate treatment.

Chronic and episodic migraines feature the same symptoms.

The patient feels moderate to severe head pain that is worsened by physical activity or movement. The pain can be on one of both sides of the head and features throbbing or pressure-like pain.

Many migraineurs are sensitive to light, sound, or smells. They may experience nausea or vomiting as well as dizziness. 

Some signs that episodic migraines may be transitioning to chronic are a growing number of migraine attacks and taking more medication due to the increased number of attacks. 

Diagnosis and Testing

There is no definitive test for migraines. The physician and patient must team together as Sherlock and Watson to determine the truth of the condition. 

To help, the patient keeps a daily migraine diary, noting down headache pain, dietary items, activities when attacks occurred. The doctor is looking for a pattern that includes when and how the migraines begin, how long they last, how often they occur, and any obvious triggers. 

The diary also describes the pain itself, including the location, severity, and how it feels. The patient also notes other symptoms, including:

• Aura (seeing a halo around objects)
• Lack of energy
• Dizziness 
• Stiff neck
• Changes in vision or other senses
• Nausea or vomiting

The healthcare provider takes a medical history that lists current and previously tried treatments, including the medications taken, the dosage, the outcome, and any side effects. The history also tracks the use of alternative or complementary therapies.

The doctor will then ask about sleep problems, depression, anxiety, or other conditions like fibromyalgia. A family history of headache is another part of the puzzle, as are whether you are taking non-headache medications and any lifestyle choices or habits, such as smoking, alcohol consumption, and caffeine intake.

Treatment

Treatment of chronic migraine is similar to that for episodic migraine.

• Acute medications for use at the onset of an attack to try to stop it
• Preventative medications to reduce the frequency and severity of the attacks
• Non-medication preventatives, such as biofeedback or cognitive behavioral therapy
• Plans for lifestyle changes to address risk factors like obesity, anxiety, snoring, and other issues

Acute medications are limited to prevent overuse or rebound headaches. The only FDA-approved preventative medication is Botox^(R). However, anti-seizure medications, antidepressants, and some blood pressure medications can help prevent or reduce migraines. 

Migraine treatment involves treating attacks when the pain is mild, beginning with simple painkillers and slowly increasing the odes as needed to the maximum tolerated. For severe migraines, the doctor may add a triptan to go along with the simple painkiller to improve its efficacy. 

Any side effects like nausea are also treated.

If those treatments do not provide relief, the physician may consider other techniques like transcranial magnetic stimulation or transcutaneous supraorbital nerve stimulation. 

Preventative treatments, like beta-blockers, angiotensin blockers, tricyclic antidepressants, anticonvulsants, and calcitonin gene-related peptides may be tried. 

Chronic migraines can keep you out of commission for most of a month. To prevent them or reduce the frequency and severity, keep a daily headache diary to find out when they occur and if there are any triggering factors like particular foods.

Don’t wait until the headaches become a daily occurrence to get help. It’s easier to stop or reverse chronic migraines if you can catch them early.  As soon as you notice an increase in the number of headaches you have each month, call your doctor or consult a migraine specialist, like the ones here at the Migraine Relief Center. 

We can help you look at your risk factors, show you how to modify them, and provide treatment and prevention options, so you can live your best life.