Episodic and Chronic Migraines: What's the Difference?

Medically Reviewed By William C. Lloyd III, MD, FACS
Woman with Anxiety

Nearly 30 million people in the United States suffer from migraine headaches. A migraine is much more than a really bad headache. Start with an ordinary, aspirin-treatable headache. Increase the pain intensity until one or both sides of your head throbs or pulses so much that pain is debilitating. Then add extreme sensitivity to light, intolerance to sound, nausea and vomiting. Finally, make it all last anywhere from four hours to three days—yes, days.

Around 20% of sufferers get a warning sign of their impending migraine called an aura—a visual disturbance in the form of light flashes, bright spots, blind spots, or wavy, zigzag lines.

A migraine is a neurological syndrome consisting of a variety of symptoms that can be traced, according to the National Institute of Neurological Disorders and Stroke, to inheriting genes that regulate the function of specific groups of brain cells, nerves, and blood vessels in the brain.

Women are nearly three times more likely to experience migraines than men. In fact, one out of three migraine sufferers are women whose attacks may be linked to changing hormone levels. Other triggers include stress, anxiety, bright lights, lack of sleep, or poor eating habits.

Episodic Versus Chronic Migraines

The difference between episodic migraine and chronic migraine is how frequently the migraines occur. Episodic migraine sufferers have fewer than 14 headaches per month for three months. Chronic migraine sufferers experience headaches 15 days or more per month. In both cases, the headaches do not have to be severe headaches or migraine headaches to count.

Episodic migraines can increase over the course of months or years to become chronic migraines. It's not clear how episodic migraines multiply and become chronic. Some researchers suspect that inflammation causes blood vessels in the brain to swell and compress nearby nerves, causing headaches. Repeated episodes of inflammation may contribute to the progression of episodic migraine to chronic migraine. It's possible that repeated episodes of inflammation cause some nerve cells in the brain to become sensitive and more likely to cause migraine pain.

A research team led by Dr. Dawn C. Buse of the Montefiore Headache Center in New York found that patients with chronic migraines had more non-headache related problems than those with episodic migraines. These problems included higher rates of unemployment and disability due to migraines and higher rates of absenteeism from work. According to the research, the chronic migraine sufferers studied were approximately twice as likely as episodic migraine sufferers to have depression, anxiety, chronic pain, and higher rates of respiratory and cardiovascular risk factors. In addition, those participants with chronic migraine have higher rates of respiratory and cardiovascular risk factors.

As painful as episodic and chronic migraines are, there is some good news on the headache front. First, migraines often improve as people age. The severe discomfort and pain may be replaced by aura symptoms alone when people reach their 50s or 60s. Second, the U.S. Food and Drug Administration (FDA) approved over-the-counter medications, such as Excedrin Migraine, Advil Migraine, and Motrin Migraine Pain, for treating migraines. However, if you find yourself taking these medications on a regular basis, see a doctor. If you take them too often, over-the-counter headache medication can actually cause medication overuse headaches.

Nearly a dozen prescription medications are available as well. For example, dihydroergotamine (DHE) can be injected or taken as a nasal spray, and sumatriptan can be injected, swallowed or taken as a nasal spray. Additionally, Botox (Botulinum Toxin Type A) injections help many migraine sufferers find relief, as do erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality), three new drugs called CGRP blockers that are injected monthly or every three months to prevent migraines and reduce severity when they do occur.

If you suspect you are suffering from episodic or chronic migraines, discuss with your doctor the various treatment options. And if you're still suffering, request a referral to a neurologist specializing in headache management. 

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  1. Buse DC et al. Sociodemographic and Comorbidity Profiles of Chronic Migraine and Episodic Migraine Sufferers. J Neurol Neurosurg Psychiatry 2010;81:428e432. 
  2. Migraine Headaches. Johns Hopkins Medicine. http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/nervous_system_disorders/migraine_head...
  3. Migraine. Mayo Clinic. http://www.mayoclinic.com/health/migraine-headache/DS00120/DSECTION=treatments-and-drugs
  4. NINDS Migraine Information Page. National Institutes of Health. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/migraine/migraine.htm
  5. Migraine: Frequently Asked Questions. U.S. Department of Health and Human Services. Office on Women’s Health. http://www.womenshealth.gov/publications/our-publications/fact-sheet/migraine.pdf
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 May 31
View All Migraine and Headache Articles
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