Chronic migraine is a neurological condition. It causes severe head pain, nausea, vomiting, and other visual and physical symptoms. When diagnosing chronic migraine, doctors look at the frequency and symptoms of a person’s headaches. At present, there are no lab tests to diagnose the condition. Once a person has a diagnosis, they can begin treatment. These include medications and trigger reduction. Read more to learn about what chronic migraine is, treatment options, and more.
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What is chronic migraine?
Chronic migraine (CM) causes a person to have at least 15 headaches per month for three or more months. To be diagnosed with CM, eight of those headache episodes should involve migraine symptoms.
People with migraine symptoms but fewer headaches per month may have episodic migraine (EM). An EM episode can last several hours. They typically occur weeks or months apart.
Symptoms
Symptoms of CM include head pain that is:
- moderate to severe
- pounding, throbbing or pulsating
- on one side of the head (unilateral) or both (bilateral)
- focused on the front or back of the head, or both
- around the eyes or behind the cheeks
- aggravated by physical activity
- severe enough for the person to miss school or work
Other CM symptoms include nausea, vomiting, and sensory symptoms such as muscle weakness and visual impairment. These sensory symptoms are called migraine with aura.
CM symptoms are similar to EM symptoms. The main difference is their frequency and duration.
Diagnosis
A person experiencing CM symptoms should contact a doctor or other healthcare professional. A doctor may refer the individual to a neurologist or headache specialist.
When determining if a person has CM, a doctor will look at headache symptoms and headache frequency and duration.
According to the International Headache Society (IHS), the diagnostic criteria for CM are:
- having a headache for 15 or more days per month for more than three months
- having at least five headaches while experiencing specific symptoms of migraine with and without aura
- having headaches on eight or more days for more than three months while experiencing symptoms of migraine with and without aura
A headache specialist usually has the person keep a headache diary. They should record their headache symptoms and frequency. This helps a doctor rule out potential causes.
In a 2019 study, researchers proposed the IHS revise the diagnostic criteria. They suggested it include people who have eight migraines per month.
Similarly, researchers in a 2021 study said the current 15-day threshold does not adequately reflect the burden of illness or treatment needs of people with CM.
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Treatment options
There are two types of treatment for CM: preventive medication and acute medication.
Acute medications are meant for the start of a migraine attack. Frequent use of these can lead to a medication overuse headache, so following a doctor’s instructions is essential.
Preventive medications are a long-term treatment option. They may reduce migraine severity and frequency.
Evidence-based preventive medications include the prophylactic treatments topiramate (Topamax) and onabotulinumtoxinA (Botox). Doctors also regularly prescribe monoclonal antibodies, such as galcanezumab (Emgality), erenumab (Aimovig), and fremanezumab (Ajovy), as preventive treatments.
Living with chronic migraine
Many people add complementary therapies to their treatment plans. They may also identify and avoid triggers.
Complementary therapies
Typically, complementary therapies are preventive techniques that do not require medication. Some examples include biofeedback and cognitive behavioral therapy.
The National Center for Complementary and Integrative Health outlines several relaxation techniques for migraine management and prevention. Examples include progressive relaxation, breathing exercises, and self-hypnosis.
Trigger management
CM triggers can vary from person to person, including lack of nutrients, sleep deprivation, and dehydration.
Mental and physical health conditions may also trigger attacks.
Conditions like depression, anxiety, and fibromyalgia can trigger or worsen migraine attacks. Treating these conditions is an integral part of managing CM.
Mental health
The American Migraine Foundation estimates about half of people with migraine also have anxiety, while around a quarter have depression.
People with mental health conditions should seek treatment. Depression and anxiety can worsen migraine symptoms and lead to additional health problems and affect the quality of life.
