Chronic migraine is a condition characterized by serious head pain, a sick feeling of stomach, vomiting, and various physical and visual symptoms. Diagnosing this condition involves evaluating the frequency and nature of an individual’s headaches. Currently, there are no laboratory tests available to determine this condition, so healthcare providers rely on patient history and symptom descriptions.
For a diagnosis of chronic migraine, an individual must experience a minimum of 15 headache days per month for 3 or more. Of these headaches, at least eight must present with migraine-specific symptoms. Once diagnosed, treatment can commence, typically involving medications and strategies to decrease headache triggers.
In contrast, individuals who experience migraine signs but have fewer headaches for a month might be diagnosed with episodic migraine. Episodic migraines are characterized by headache episodes that remains many hours and occur less frequently, usually weeks or even months.
Symptoms
CM presents with a range of symptoms, primarily characterized by head pain that can be intermediate to heavy in intensity. This pain often feels throbbing, pounding, or pulsating and may affect one side of the head or both sides. The pain can be concentrated at the back or front of the head, or even around the eyes and back of the cheeks. It is typically irritated by physical activity and can be serious enough to cause missed days at work or school.
In addition to head pain, chronic migraine is associated with other symptoms like nausea and vomiting. Sensory symptoms, including visual disturbances and muscle weakness, are also common and are referred to as migraine with aura.
While the symptoms of chronic migraine share similarities with those of episodic migraine (EM), the primary distinctions lie in their duration and frequency.
Causes
Episodic migraines, which occur occasionally, can sometimes become chronic, leading to frequent headaches. This transformation can be triggered by several factors, including hormonal alterations, illness, or stress. Genetics might also play a role in developing chronic migraines.
The National Headache Foundation reports that nearly 80% of people with chronic migraines use medication too often. This overuse can actually worsen the occurrence of migraine attacks and may cause additional headaches called rebound headaches or medication overutilizes headaches. Rebound headaches occur when medications taken for quick relief of migraine pain are used too frequently.
Medication overutilize is generally defined by how often a person takes acute migraine medicines each month. Typically, using these medications 10-15 days a month can lead to problems. Drugs linked to medication overutilize headaches include triptans, opioids, ergotamines, and even common unprescribed pain relievers like acetaminophen and nonsteroidal anti-inflammatory drugs like ibuprofen.
Diagnosis
If someone is experiencing symptoms of CM, they should consult a healthcare provider or other doctor. Often, the healthcare provider may refer the patient to a neurologist or a specialist for further evaluation.
To diagnose CM, healthcare providers assess both the symptoms and the frequency and duration of headaches. According to the International Headache Society, the criteria for diagnosing CM include having 15 headaches or more a month for over three months. Additionally, the individual must have at least five headaches with migraine symptoms, either without or with aura, and experience 8 headaches or more a month for more than 3 months with similar symptoms.
A specialist may ask the patient to maintain a headache diary, noting the symptoms and frequency of headaches. This record helps the healthcare provider identify potential causes and eliminate other conditions.
Treatment
There are two main kinds of treatment for chronic migraine: acute medications and preventive medications.
Acute medications are used to address migraine symptoms once an attack begins. These medications help to relieve the pain and discomfort of a migraine. However, using them too often can lead to a condition known as medicine overutilized headache. To avoid this, it’s crucial to follow the healthcare provider’s instructions carefully and use these medications only as prescribed.
Preventive medications are designed to be taken regularly to reduce the frequency and seriousness of migraines over the long term. These medications aim to prevent migraines from occurring in the first place.
Effective preventive medications include:
- Topiramate and onabotulinumtoxinA, have been shown to help decrease migraine frequency and intensity.
- Monoclonal antibodies, such as galcanezumab, erenumab, and fremanezumab, are also commonly prescribed. These medications work by targeting specific molecules involved in migraine attacks, providing long-term relief.
Your doctor will help determine the best treatment plan based on your individual needs and the specifics of your condition.
Coping
Living with a migraine can be extremely challenging, making it hard to study, work, or even carry out everyday activities. Migraine attacks often remain in the middle of 4 to 72 hours, and sometimes even longer, up to a week.
Many people with chronic or transformed migraine also experience feelings of isolation and may struggle with anxiety or depression due to their condition. The impact on their daily lives and mental health can be significant.
Fortunately, there are many resources available to help cope with migraines. Support groups, both in-person and online, can offer valuable connections and advice for patients, in addition to their caregivers and families. Your healthcare provider can assist you in finding these support groups.
When to consult a healthcare provider
If you are experiencing symptoms of a migraine headache, it is advisable to contact a healthcare provider for evaluation. For individuals who already have a diagnosis of chronic migraine, it is important to reach out to a healthcare provider if you notice that your migraine episodes are becoming more frequent or severe.
There are specific situations where immediate medical attention is necessary. If you experience new or unusual symptoms alongside your migraine, such as a sick feeling of stomach and vomiting, vision loss or double vision, impaired speech, dizziness or weakness, body numbness, confusion, fever, trouble breathing, or seizures, these could specify a medical emergency. Such symptoms, or an unusual or sudden migraine attack, should be evaluated urgently.
You should also go to the emergency room if you get migraine episodes under certain conditions. These include experiencing a migraine after a head trauma, during pregnancy, alongside another serious medical condition liver, kidney, or heart disease, or in the presence of an immune system disorder like HIV/AIDS.
Summary
Chronic migraine is a debilitating condition causing severe, frequent headaches that can last from 4 hours to a week. Treatment includes acute medications for immediate relief and preventive medications to decrease the frequency and severity of attacks. Overuse of acute medications can lead to medication overutilizing headaches, worsening the condition. For those with CM, it’s crucial to consult a healthcare provider if symptoms worsen or if new, severe symptoms happen, such as vision loss or difficulty breathing. Immediate medical attention is required in cases of sudden, unusual migraine attacks or if migraines occur with other serious conditions. Support groups and resources are available to help manage the impact of CM.
