Chronic Migraine: Treatment, Symptoms and Causes

Chronic migraine is a neurological disorder and a kind of headache that affects a person 15 days a month for at least three consecutive months, with eight having migraine symptoms. It usually starts with less frequent headache episodes but changes into a more frequent headache pattern with time

Almost 3 to 5% of people in the US suffer from chronic migraine each year, and nearly 3% of people with episodic migraine transform into chronic migraine each year. Chronic vestibular migraine is a nervous system problem that causes the patient to feel repeated dizziness.

Chronic Migraine Causes

Behind the development of chronic migraine in a specific person, there are several causes. Some of them are the following:

  • Number of episodic headaches that increases gradually over time
  • Overweight or obesity
  • Sleep apnoea
  • Snoring
  • Excessive use of caffeine
  • Disorder in the central nervous system
  • Genetic factor
  • Vascular irregularities
  • Depression
  • Anxiety
  • Pregnancy: Hormonal changes, stress and skipped meals in pregnancy can also cause chronic migraine.
  • Suffering from severe emotional and stressful life events or physical trauma
  • Excessive use of medicines that are used to control the episodes of headache, such as Barbiturate-containing medications and narcotics
  • Use of most common drugs which cause medication overuse headaches include Excedrin, acetaminophen (Tylenol), and non-steroidal anti-inflammatory medications.

Chronic Migraine Symptoms

The symptoms of chronic and episodic migraine are the same, but the primary difference is the increase in the frequency of the number of headaches. Symptoms of migraine are the following:

  • Dizziness
  • Pain in a specific part or all head
  • Pressure like pain
  • Nausea/vomiting
  • Throbbing pain
  • Patients become sensitive to light, smell, and sound
  • Headache turned from moderate to severe and got worse with physical activity

Specific symptoms which show that episodic migraine turning chronic migraine are the following:

  • An increased number of migraine attacks gradually
  • Use of more medication due to these growing attacks

Chronic Migraine Diagnosis

During diagnosis, the doctor will ask you about detailed medical and family history and the symptoms you are facing at that time. The doctor may ask the following things:

  • The pattern of migraine that you were facing at that time, he may ask when and how it begins, whether it is episodic or continuous, how much time it takes to end, whether it comes and go, or whether there is any factor or activity that make migraine worse.
  • He may ask about other symptoms you face with migraines, such as vomiting/nausea, lack of energy, dizziness, vision changes, and stiff neck.
  • The details of pain, including sensation, location, and severity
  • Detail about your current and previous treatment, about use of medications, about use of current non-headache medicines, side effects, and outcomes of that therapies
  • Other health problems such as anxiety, depression, fibromyalgia, sleep apnoea, family history of headaches, and other lifestyle choices (use of Alcohol, caffeine, and cigarette

Chronic Migraine Treatment

Chronic migraine can be treated by managing lifestyle choices, attacks, and headache triggers, and favorable preventive treatment helps reduce migraine attacks. Keep a record of your daily headache in a diary. If you notice any increase in headaches, immediately consult with the doctor. Chronic migraine disorder will be recovered quickly if detected in earlier stages.

Lifestyle Changes

Some lifestyle changes which help reduce chronic migraine:

  • Control of weight
  • Start healthy physical activities and exercise plans prescribed by the doctor.
  • Always stay hydrated
  • Adopt a strict routine regarding your meal and snack time, stick to that routine, and never skip a meal
  • Getting rid mood disorders such as anxiety and depression or sleep apnea
  • Use techniques such as relaxation training, meditation, yoga, and mindful breathing to manage the stress

Managing migraine attacks

The treatment plan that is used to manage migraine attacks are following:

  • When the pain is mild in the early stage, try to treat migraine through simple pain killers such as ibuprofen, paracetamol, and aspirin.
  • Increase the dose of these pain killers when the headache starts turning into a severe condition
  • Always try to avoid using opiates, and use triptan in the medications to treat severe chronic headaches and improve efficacy.
  • Avoid overuse of medicine because it may worsen the headache.
  • Try to treat the related side effects of chronic migraine such as nausea or vomiting to manage migraine attacks.
  • Also, try other treatment techniques, transcutaneous supraorbital nerve stimulation and transcranial magnetic stimulation, to treat chronic migraine.

Chronic Migraine Preventive

Preventive treatment with different medications helps reduce the number of headaches. These preventative treatments include the following:

  • Antidepressants: Antidepressants help treat chronic headaches and anxiety, depression, and sleep apnea. This tricyclic anti-depressant is nortriptyline (Pamelor), used to treat chronic headaches. Other anti-depressants such as selective serotonin reuptake inhibitor (SSRI) and fluoxetine (Prozac, Sarafem, and others) also treat chronic headaches. Still, a placebo is more effective than these medications for headaches.
  • Beta-blockers: Drugs such as metoprolol (Lopressor, Toprol-XL), propranolol (Inderal, Innopran XL), and atenolol(Tenormin) are not only helpful in preventing episodic migraine but also helpful in treating high blood pressure.
  • NSAIDs: Non-steroidal anti-inflammatory drugs prescribed by the doctor, such as naproxen sodium(Naprelan, Anaprox), are also helpful in relieving pain if you take them with other pain killers. They are useful when the headache turns severe.
  • Anti-seizure medications: Anti-seizure medications such as gabapentin (Neurontin), topiramate(Topamax, Qudexy XR, others), and divalproex sodium (Depakote) help prevent migraines and daily chronic headaches.
  • Botulinum toxin: For people who don’t get relief from the above-given medication, OnabotulinumtoxinA (Botox) injection is an effective option for relieving chronic headaches.


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