Q&A: Chronic migraine
By: Steph Weatherley, Senior Information and Support Adviser, The Migraine Trust
In this blog, we answer common questions about chronic migraine that we hear on The Migraine Trust helpline.
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.
Symptoms of chronic migraine can include frequent headache, increased sensitivity to light, sound or smells, nausea and vomiting. Other symptoms include aura (such as visual disturbances, problems with speech, numbness or pins and needles), dizziness and vertigo (a sensation of spinning).
We still don’t know exactly what causes chronic migraine. For a lot of people chronic migraine develops gradually with migraine attacks becoming more frequent over time, changing from episodic migraine to chronic migraine. The pattern of chronic migraine will vary depending on 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.
How is chronic migraine treated?
Treating chronic migraine can be a challenge, and a lot of people find that they need to try a range of different treatments to help get it under control. It’s also difficult because an effective preventive treatment is around a 50% reduction in the frequency and severity of migraine, however, when you have chronic migraine this can still mean a lot of days with migraine.
The standard approach to treating chronic migraine usually involves trying different oral preventives to try and reduce how often you have attacks, and how severe they are. We have a list of recommended preventive medications with doses, which aim to make you less sensitive to triggers and less likely to have attacks. You can discuss the options with your doctor. If (once you have tried at least three preventive medications at an effective dose for a suitable length of time) these don’t work or aren’t suitable (e.g. because they’re causing side effects) the next step is to be referred to either a neurologist or a headache specialist.
You can check with your doctor if triptans, soluble paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are safe for you to use when you have an attack. These can be combined or used individually at the start of an attack with anti-nausea medication if needed. Often, stomach absorption becomes sluggish at the start of an attack and an anti-sickness drug called domperidone can help with absorption (and nausea) if taken early.
Limiting painkillers is important to avoid medication overuse headache and to allow the preventive medicines to work better. For example, triptans should not be used on more than 10 days per month.
Are there any non-drug treatment options for chronic migraine?
Not everyone wishes to take drug medications for their migraine. Some people try supplements such as riboflavin (B2) (400mg a day), magnesium (400mg a day) or co-enzyme Q10 (150mg a day). These provide relief for some people. Similarly to preventive treatments it can take around six to eight weeks to see a benefit and three months to see the full impact. Some people choose to take all three supplements together or try each one individually – it’s often down to personal preference.
Some people also report that acupuncture can be helpful. Others also find some devices useful such as the Cefaly device, however, this does not work for everyone. Cefaly offer a 60-day cooling off period where the device can be returned and a partial refund is given. You can read more about the device and user testimonials on their website.
Where can I get support?
There are very few support groups for people with migraine in the UK currently. Some headache clinics do run groups and support sessions for patients. Some local areas run groups for people with long-term conditions, which can include migraine and pain conditions. You can see if there are any available near you by contacting your local authority or local wellbeing hub. There are also a few migraine forums on HealthUnlocked (which is an online support community) and Facebook. PainConcern run an online forum for people to share their experiences, which some people with migraine find helpful.
Migraine has a huge impact on wellbeing, and the nature of trying to find a treatment is very challenging for a lot of people which can add to the anxiety and stress. Many people with migraine find support such as counselling, CBT or other psychological approaches helpful. We have a blog from a clinical psychologist about the benefits of support for people with migraine, and also some suggestions for how to access support. We also have a useful blog on migraine and anxiety here.
If you or a loved one has questions about migraine or is in need of support, you can contact us via our free helpline on 0808 802 0066 or online here. You can also chat to us online through our live chat service at migrainetrust.org.
Read about Marième’s experience of growing up with chronic migraine here. Find out more about medication overuse headache here.