What is chronic migraine?

Chronic migraine is defined as having headache on at least 15 days per month, with eight of these having migraine symptoms, for at least three months. People who have fewer headache days with migraine symptoms have episodic migraine.

If you have chronic migraine your symptoms may include:

• frequent headache
• increased sensitivity to light, sound or smells
• nausea (feeling sick)
• vomiting (being sick).

Other symptoms include aura (such as visual disturbances, problems with speech, numbness or pins and needles), dizziness and vertigo (a sensation of spinning).

What causes chronic migraine?

It’s not fully understood what causes chronic migraine.

For a lot of people chronic migraine develops gradually with migraine attacks becoming more frequent over time. Around 2.5 out of 100 people with episodic migraine will develop chronic migraine each year. For some people (around 2 out of 10) chronic migraine will go into remission within 2 years of becoming chronic.

The pattern of chronic migraine will vary depending on your individual circumstances. For some people it may return to episodic migraine, some people find it stays the same and others find that it gets worse.

There are a number of medical conditions that can increase your tendency to have migraine. These include:

• depression
• anxiety
• other pain conditions such as Fibromyalgia
• sleep apnoea
• Postural orthostatic tachycardia syndrome (PoTS)

Managing these can help with managing migraine and the effectiveness of migraine treatment.

Impact of chronic migraine

If you have chronic migraine it will have a huge impact on your daily life. Chronic migraine is related to greater disability and has a huge impact on your physical, social and work life. It can also have a huge impact on your relationships. Many people with chronic migraine report lower quality of life and poorer health than people with episodic migraine.

It can be challenging to find an appropriate treatment and you may have spent years trying to find a way to make your migraine manageable.

If you are struggling with chronic migraine speak to your GP, specialist or contact our Helpline.

Medication overuse headache

Around 2/3 of people with chronic migraine experience medication overuse headache. This is where acute treatments such as triptans or over-the-counter painkillers are taken on too many days of the month. They stop treating the head pain and start causing daily headaches.

If you are regularly taking painkillers for your migraine it’s important to speak to your doctor about medication overuse headache. Managing medication overuse headache is important because if it is left untreated it can lead to preventive treatments being less effective. It also has a negative impact on you and your quality of life. There is more information on medication overuse headache here.

Diagnosing chronic migraine

If you’re experiencing headache more than 15 days per month, with at least eight featuring migraine symptoms,  you should speak to your GP. Chronic migraine is hugely debilitating, but there are treatments available that can help you to manage your symptoms.

There is no test to diagnose migraine. To diagnose chronic migraine your doctor will usually:

• ask you about your symptoms and history of migraine and headache. It can be helpful to keep a headache diary detailing your symptoms.
• perform a neurological examination.

In chronic migraine your doctor may want to do extra tests to rule out other potential causes of your symptoms. You may also be referred to a headache specialist to help with diagnosis or management of your symptoms.

Treatment options for chronic migraine

Treatment for chronic migraine usually involves different approaches including drug and non-drug options. However, most people with chronic migraine will need to take medication to help manage their symptoms.

Acute

With the risk of medication overuse headache and the constant nature of chronic migraine it can be challenging to know when to take acute medicines to help with your migraine attacks.

If you can identify ‘good’ and ‘bad’ days or have clear times when your symptoms get worse that can help with when to use acute medication such as triptans or over-the-counter painkillers.

When taking painkillers or triptans it can help to treat at the right time (when the head pain starts). You can start with over-the-counter painkillers and move to triptans if these don’t work. You should try not to take them on more than 2 days per week and avoid opiate based treatments such as codeine. You can take medication for any related symptoms such as anti-sickness medication.

Preventive

Preventive treatment aims to reduce how often you have migraine and how bad they are. These are often needed in chronic migraine.

There are different preventive treatments available. The treatment you’re offered will depend on a range of factors including your migraine pattern, any other health conditions you have, your preference and potential side effects.

There are 4 main drug classes that GPs can prescribe as preventive treatments . These are beta-blockers, tricyclic antidepressants, anti-epilepsy drugs and the blood pressure tablet candesartan.

With oral preventives you usually start at a low dose and gradually increase. Some people may need to stay on a lower dose for longer and increase the dosage more gradually, if side effects develop. Medication is usually increased until it works, the side effects are too much or the maximum dose is reached.

If you try one and it doesn’t work you should try another one. If it works you should continue on it for a few months before the dose is lowered. For most people this doesn’t cause symptoms to get worse.

If you’ve tried a range of treatments available via your GP and they haven’t worked or are unsuitable you can be referred to a headache specialist.

A headache specialist will review your history and has access to a wider range of treatments, which may include Botox, calcitonin gene-related peptide (CGRP) monoclonal antibodies or a Greater Occipital Nerve (GON) block.

Non-drug options

Some people with chronic migraine find non-drug treatments helpful. Often these work best when used alongside other treatment options. Non-drug options include:

• supplements – such as riboflavin (B2), magnesium or co-enzyme Q10
• acupuncture
• devices such as Cefaly or gammaCore

Other things which you may find helpful include relaxation techniques and psychological interventions (such as CBT).

Triggers/Lifestyle changes

For some people with chronic migraine reviewing triggers and looking at lifestyle changes can be helpful. Disrupted sleep and stress are common triggers. However, not everyone can identify triggers, not all triggers can be managed and for some people it may not help. A lot of people with chronic migraine find that triggers and lifestyle changes can be hard to identify until their symptoms start to improve.