What is chronic migraine?
Chronic migraine is described as fifteen headache days a month, with at least eight migraine-like headaches per month, for at least three months. Initially, chronic headaches begin as less frequent headache episodes that gradually transform into more frequent headaches.
Who suffers from chronic migraines?
In the United States, a third to a fifth of the population suffers from chronic migraine. Annually, about 3 percent of people with episodic migraines become chronic migraineurs.
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What are the symptoms of chronic migraine?
Chronic migraine has the same symptoms as episodic migraine. However, the headaches become more frequent in chronic migraine. Symptoms of migraine usually include:
- Headaches that are moderate to severely intense and worsen with activity
- One-sided or bilateral headaches
- Pain that feels as if it is throbbing or pressing
- Smell, light, and sound sensitivity
Migraines that are transitioning from episodic migraines to chronic migraines include:
- Increasing numbers of migraine attacks
- More medication is needed to handle more migraine attacks
What causes chronic migraine?
There are several factors responsible for chronic migraine:
- There is a steady increase in headaches over time.
- Attempts to control the increasing number of headaches lead to the overuse of medications that were once used to treat headaches. The most widely reported prescription medications that lead to chronic headaches are barbiturate-containing drugs (amobarbital [Amytal®], butabarbital [Butisol®]) and opiates (opioids/opiates). Over-the-counter drugs such as Excedrin® and generic equivalents are the most commonly associated with medication overuse headaches, as are non-steroidal anti-inflammatory medications and acetaminophen (Tylenol®).
Chronic migraine can also be caused by:
- Mood disorders, such as anxiety and depression
- Sleep disturbances
- An excessive intake of caffeine
- Past trauma (traumatic events or severe emotional stress)
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Chronic migraine diagnosis
The doctor will conduct a comprehensive health history. These questions will be asked:
- Describe your headache pattern, including when and how headaches occur; if they’re episodic or persistent; how long the headache lasts; and if there are any factors that make the headache worse.
- Describe where, what sensations you are experiencing, and how intense the pain is.
- Pain may be accompanied by other symptoms, like auras, lack of energy, stiff neck, dizziness, changes in vision or perception, and nausea/vomiting.
- Treatments you are currently or have tried in the past, including dosage, time taken to take the medication, outcome, side effects, and alternative or complementary therapies.
- You may also be asked about problems you have with your sleep, depression, anxiety, or fibromyalgia, your family history of headache, current non-headache medication, and your lifestyle choices (smoker, alcohol consumer, caffeine consumption).
What is the treatment of chronic migraine?
Patients with chronic migraine are treated by maintaining a healthy lifestyle, managing headache triggers, managing migraine attacks, and implementing preventive measures to minimize migraine attacks.
Some of the lifestyle changes include:
- Eating less and exercising more
- Following a doctor-approved exercise plan
- Stress management. You can learn to control your stress by meditating, practicing yoga, or doing relaxation exercises
- Establish a regular schedule for mealtimes and snack times
- Drink plenty of water
- Starting treatment for mood disorders (including depression, anxiety, and sleep disorders)
Common chronic migraine treatment guidelines:
- Start doses of painkillers early when migraine pain is mild; simply increase the dose as needed to the maximum tolerated dose (paracetamol, aspirin, ibuprofen, naproxen) unless the headache is severe or likely to become severe. You can improve efficacy by adding a triptan to any of the above medications. It is best to avoid opiates. Overusing medications will worsen chronic headaches, so your doctor will devise a treatment plan.
- Take care of nausea as well.
- It is important to consider alternative treatment options, including transcranial magnetic stimulation and transcutaneous supraorbital nerve stimulation.
Preventive treatment is intended to reduce headache frequency. Preventive treatment includes:
- Atenolol (Tenormin®), propranolol (Inderal®), and metoprolol (Lopressor®) are beta blockers
- Atacand®, a drug that blocks angiotensin
- Nortriptyline (Pamelor ®) and amitriptyline (Elavil ®), which act on the central nervous system to relieve depression
- Medications such as sodium valproate and topiramate (Topimax®)
- Flunarizine (Sibelium®)
- Onabotulinum toxin A (Botox®) injections
- Galcanezumab and fremanezumab (Ajovy® and Aimovig®) are CGRPs, such as galcanezumab and fremanezumab
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Is it possible to prevent chronic migraines?
Record your headaches every day. See your headache specialist as soon as you begin to suffer from headaches more frequently. Consult a physician as soon as you notice headaches on a regular basis. You are more likely to be able to treat chronic migraine when caught early.
Consider the risk factors and modify those that you can (see the lifestyle changes above).
What’s the outlook for people with chronic migraine?
Those with chronic migraine can hope to control their symptoms. If migraine headaches are treated correctly, it is reasonable to expect a reduction in their frequency and severity. It is common for migraine sufferers to relapse after a period of chronic migraine.
If previous treatments have not worked for those suffering from chronic migraines, other options are available. Nerve blocks and trigger point injections are among the more aggressive hand-on techniques needed by some patients.
Patients with medication overuse headaches, especially those requiring detoxification, will be treated in a monitored setting, such as an infusion suite, in order to rid their bodies of previous medications. Infusion therapy treats migraines, nausea, and vomiting in patients receiving intravenous medication.
It requires a team approach to treat migraine sufferers who do not respond to any treatments, do not respond to detoxification efforts, or use medications that do not improve their condition.
A team of healthcare professionals, including neurologists, psychiaters, psychologists, nurses, physical therapists, and social workers, meet with each patient and their families on a weekly basis to develop a plan of care and to monitor progress. If you have migraines that are difficult to treat, ask your doctor to refer you to a treatment facility that offers multi-disciplinary patient-centered services.