Chronic Migraine: Understanding Your Diagnosis

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If you’ve recently been diagnosed with chronic migraine, you know how debilitating these headaches can be. While getting an accurate diagnosis may feel like a relief, you probably still have a lot of questions. What exactly does chronic migraine mean? Are you going to have these headaches forever?

Most everyone gets headaches at some point, but not everyone experiences migraines. It’s estimated about 12% of the population suffers from migraine attacks, and only 1 to 2% of will develop chronic migraine. To meet the criteria for chronic migraine, you must have headaches more than 15 days a month for at least three months, and at least eight of your headaches must have features of migraines.

Migraines can be differentiated from headaches by some of the following characteristics:

• Moderate to severe head pain, often on one side of the head but can occur on both
• Throbbing or pulsing head pain
• Nausea or vomiting
• Sensitivity to light, sound, smell, or touch
• Dizziness

Some people also develop an aura just prior to a migraine. This often causes visual changes, like seeing spots or flashes of light, or losing part of your field of vision.

A neurologist, a doctor who specializes in chronic migraine and other disorders of the brain and nervous system, will usually determine the diagnosis. Seeing a neurologist who focuses solely on patients like you–a migraine and headache specialist–can ensure you receive the best quality care. The diagnosis is made based on your pattern and description of headaches, your medical and family history, treatments you have tried, and a physical and neurological examination.

Chronic migraine usually starts as less frequent, also called episodic, migraines that eventually increase over time. Certain risk factors can make this more likely to occur. These include:

• Poorly treated headaches
• Obesity
• Anxiety or depression
• Caffeine use
• Poor sleep
• Snoring
• Stress

Another important risk factor for developing chronic migraine is overuse of headache medications. Though it may seem contrary to what you’d expect, rebound headaches can occur after frequent, long-term use of headache pain relievers. This includes over-the-counter medications, such as ibuprofen (Advil) or Excedrin, which combines aspirin, paracetamol, and caffeine, as well as prescription drugs, including sumatriptan (Imitrex) and narcotics.

Effective chronic migraine treatment focuses on relieving migraines once they start and preventing them from occurring in the first place. This can incorporate:

• Acute migraine treatments: It’s best to treat migraine pain with medication when it first starts, but be cautious about how often you use it. More than 10 times per month can lead to medication overuse headaches. Avoid medications containing barbiturates or narcotics. Treat other symptoms like nausea or vomiting as directed by your doctor.
• Prophylactic migraine treatments: Onabotulinum toxin A (Botox) injections and topiramate, an anti-seizure medication, are often effective at preventing chronic migraines. Beta blockers, a type of blood pressure medication, and some anti-depressants may also be prescribed as treatment.
• Lifestyle changes: Addressing chronic migraine risk factors, such as losing weight or limiting caffeine, may decrease migraine frequency.
• Non-medication treatments: Treatments to reduce stress and improve your quality of life may help. Examples are hypnotherapy, yoga, acupuncture, and physical therapy.
• New migraine treatments: As we continue to learn more about what’s happening within the brain to cause chronic migraines, new therapies are being developed. For example, calcitonin gene-related peptide (CGRP) is a protein in the body that plays a role in causing migraines. Medications, such as galcanezumab (Emgality) and erenumab (Aimovig), target and stop CGRP from working. They appear to be effective for migraine prevention and treatment.

Chronic migraine can be challenging and may have a significant impact on your day-to-day life. But hang in there. Pay attention to your body, track your headaches, stick your treatment plan, and work with your chronic migraine doctor to find the relief you deserve.