Chronic Migraines: Symptoms, Causes, Treatment

Migraines are more than just a headache: The pulsating head pain can cause nausea, vomiting, and sensitivity to light and sound for up to three days.

And when migraines happen often, they’re chronic: 1.4-2.2% of people suffer from chronic migraines, with persistent symptoms that can start to take over their lives.

In this article, I’ll explain more about chronic migraines, including who is prone to them, what causes these headaches, how you can treat and prevent them, and more.

I’ll also talk about when to see your doctor about chronic migraines.

What are Chronic Migraines? 

To be diagnosed with chronic migraine you must have 15 or more headache days per month for three or more months, and you must have migraine symptoms for at least eight of those 15 days. 

If someone has migraines, but has them less often than 15 days per month, they have “episodic migraines.”

In most cases, people who suffer from chronic migraines will have experienced episodic migraines that steadily increased over time.

About 3% of people with episodic migraine transition to having chronic migraines every year. 

Who gets chronic migraines? 

Anyone who suffers from episodic migraines can develop chronic migraines.

There are, however, certain risk factors that make chronic migraines more likely in some people, including:

• Depression and/or anxiety
• A family history of episodic or chronic migraines
• Snoring
• Pain disorders
• Obesity
• Asthma 
• Trauma to the neck or head
• Frequent nausea
• Being susceptible to intense emotional trauma
• Overusing medications

Women are three times more likely than men to suffer from migraines.

Though they can start at any time, migraines tend to begin after adolescence and peak at the age of 30, then become less frequent and less severe as time goes on.

Causes

In most cases of chronic migraine, migraines turn from episodic to chronic naturally, increasing in frequency over time.

In some cases, however, medication overuse can be the cause.

Medications used in an effort to treat migraines can actually become the cause for more migraines due to overuse.

These headaches are often referred to as “medication overuse headaches” and can become chronic as sufferers continue to increase medication use in order to treat them, causing a negative feedback loop.

The most common medications that cause chronic migraines as a result of medication overuse are over-the-counter drugs like acetaminophen, non-steroidal anti-inflammatory (NSAIDs, like ibuprofen) medications, headache-specific medications like Excedrin, as well as prescription narcotics and barbiturate-containing medications. 

Common migraine triggers

• Sleep changes, including too much or too little sleep
• Stress
• Alcohol (especially wine)
• Caffeine
• Hormonal changes 
• Skipping meals
• Weather changes
• Medications (like oral contraceptives and vasodilators)
• Intense physical exertion

Symptoms

The symptoms for chronic migraines and episodic migraines are the same—the only difference is frequency.

These symptoms include:

• Moderate to severe head pain that worsens with movement
• Head pain that is throbbing and/or pressure-like
• Pain on one side or both sides of the head
• Dizziness
• Nausea and/or vomiting
• Sensitivity to light, sounds, smells

While the symptoms for chronic migraines and episodic migraines are the same, there are several signs that your episodic migraines may be turning into chronic migraines.

These signs include:

• The frequency in which you are experiencing migraines is increasing
• Your medication use to treat the migraines is increasing 

Diagnosis

To diagnose chronic migraine, your doctor will ask you a series of questions related to your symptoms, family history, migraine history, medical history, and medication history:

• How long do your migraines typically last?
• What migraine triggers do you notice?
• What other symptoms accompany your head pain?
• What does your head pain feel like, including sensation, severity, and location?
• Do you have any other medical or mental health conditions?
• Do you have a family history of episodic or chronic migraine?
• What medications have you tried to help your migraine pain, and what are you currently taking? 
• Have you tried any other forms of treatment for your migraines?

Your doctor may also choose to give you a physical and neurological examination.

Once they feel like they have an accurate understanding of your situation, they can make a diagnosis. 

If they think that your situation is complex—or if your symptoms are unusually intense—your doctor may run a series of tests to ensure that you do not have a more serious underlying condition causing your chronic head pain.

Generally, these tests include magnetic resonance imaging (MRI) or a computerized tomography (CT) scan.

Treatment

Chronic migraines and episodic migraines are generally treated through lifestyle changes and medication.

However, there are a few key differences in treatment for the two conditions—especially when it comes to medications. 

Lifestyle changes

As a part of your treatment plan, your doctor may recommend one or more lifestyle changes to address risk factors related to chronic migraines: 

• Managing stress (through yoga, meditation, therapy)
• Losing weight if you are overweight 
• Maintaining good sleep hygiene, including keeping consistent sleep and wake times, and avoiding screens before bed
• Treating mood disorders like anxiety and depression
• Eating regular meals and staying hydrated
• Exercising regularly

Other non-drug treatments for chronic migraine can include acupuncture, cognitive behavioral therapy, meditation, and yoga. 

Medication 

Chronic migraines are generally treated with the same medications used for episodic migraines. 

These medications, designed to treat migraine symptoms as soon as they occur, should be taken as quickly as possible once you feel a migraine coming on, as they are most effective at this stage.

Acute medications for migraines include:

• Over-the-counter pain relievers: Generally the first line of defense, these can include acetaminophen, naproxen, and ibuprofen. Some medications, like Excedrin, are a combination of a pain reliever and caffeine.

• Triptans: A family of prescription drugs designed to block pain receptors in the brain. These include sumatriptan and rizatriptan, and are very effective at stopping migraines.

• Anti-nausea medications: These medications, including chlorpromazine and metoclopramide, are highly effective when combined with a pain reliever. 

• Opioid medications: These highly addictive medications are generally only used as a last resort, and are often ineffective at treating migraines.

Prevention

There are a number of different medications that are designed to prevent migraines before they start.

These preventative medications can help reduce the frequency of your migraines, the severity of your symptoms, and how long they last when they do occur.

These preventative medications include, but are not limited to:

• Certain blood pressure-lowering medications, like beta blockers (such as propranolol) or calcium channel blockers (such as verapamil) 
• Certain anti-seizure medications (such as valproate and topiramate) 
• Tricyclic antidepressants
• Calcitonin gene-related peptide (CGRP) monoclonal antibodies (example: galcanezumab and fremanezumab)
• Botox (onabotulinumtoxinA) injections every 10-12 weeks

It’s also important to keep track of your headaches.

Experts suggest keeping a migraine diary, and seeing a headache specialist if you notice the frequency of your migraines increasing.

It is easier to stop or reverse chronic migraines if you address the issue early. 

Complications 

People who suffer from chronic migraines are more likely than the average population to suffer complications such as:

• Depression and/or anxiety
• Insomnia or other sleep disorders
• Migrainous stroke
• Migraine-triggered seizures 
• Vertigo 
• Medication-overuse headaches

When to See a Doctor  

You can live a normal, healthy life even if you have developed chronic migraines—but you’ll need to get some help from your doctor in order to treat and prevent them.

Talk to your doctor if your headaches are:

• Becoming more frequent or more severe
• Keeping you from performing normal daily activities
• Worsening or not improving with the help of over-the-counter medications
• Causing you distress

There are also some situations in which you should seek emergency medical treatment for a headache in order to rule out serious conditions like stroke, encephalitis, and meningitis.

Go to the emergency room or call 9-1-1 if your headache is the most severe you have ever experienced, or if the headache is accompanied by one of the following:

• High fever (102-104° F)
• Trouble speaking, seeing, or walking
• Confusion 
• Fainting, numbness, or weakness
• Stiff neck
• Nausea or vomiting (when not related to another health issue, like the flu)

How K Health Can Help

Did you know you can get affordable primary care with the K Health app? Download K Health to check your symptoms, explore conditions and treatments, and if needed text with a provider in minutes. K Health’s AI-powered app is based on 20 years of clinical data.