Chronic Migraine

Chronic Migraine is a very discomforting condition that affected about 4.5 % of the population in the US alone as long back as 1989. In recent years, its incidence has just got bigger. Read and know what Chronic Migraine is as well as its causes, symptoms, diagnosis and treatment.

Chronic Migraine Definition

The term “Migraine Headache” refers to a type of headache that is marked by the enlargement of the blood vessels in the head. It is different from regular headaches, which are characterized by the constriction of the blood vessels.

Chronic Migraine refers to a type of migraine headache that persists for over 15 days out of every month or more than three months. It occurs for a longer period than regular migraine headaches. Previously, this condition was known as “Transformed Migraine (TM)”.

Chronic Migraine Symptoms

The condition gives rise to various types of pain as well as different other symptoms. Many individuals suffering from this type of a headache experience pain at the back of one or both eyes or on one side of their head. The pain is generally restricted to a particular area. Chronic Migraine pain may be sharp in nature or characterized by constant throbbing.

Certain individuals with this type of headaches experience symptoms like

  • Pain in neck
  • Light sensitivity
  • Sensitivity to sound
  • Vomiting
  • Nausea

Sometimes, people with this disorder may suffer from an aura, a symptom that happens when the sufferer sees red or black spots or flashes of bright light. According to some sufferers of this condition, the sensation is similar to a camera being directly flashed in the eye. An aura may also result in blurred vision.

Chronic Migraine Causes

Some of the main causes of Chronic Migraine headaches are:

Hormonal Imbalance

Serotonin levels have been found to drop whenever a migraine headache appears. This results in release of neuropeptides and consequent rise of painful symptoms which includes development of CM headaches.

In many women fluctuations of the estrogen hormone can trigger migraines. The hormonal imbalance leads to severe headaches as women go through menstrual cycles or menopausal stage. Other women suffer from such headaches while they are in the stages of pregnancy.


Certain foods give rise to allergenic symptoms or sensitivity in sufferers, leading to the appearance of migraines. Such food items can be

  • Cheese, especially old ones
  • Sour cream
  • Chocolate
  • Certain types of fish

Additives like Monosodium Glutamate (MSG) and artificial sweeteners such as Aspartame can also act as triggers for these persistent migraine headaches. Alcoholic beverages, particularly red wine and beer, are common triggers for these headaches. Skipping meals can also lead to the appearance of migraines in some people.

Bodily changes

The human body reacts to changes in different ways. Mental stress, in the form of pressure at home or workplace, can act as a big trigger for many individuals. Changes in patterns of sleep due to any reason can set the body in motion as a bodily reaction against migraine headache.

Some factors, that can bring about a bodily change, and give rise to CM headaches include

  • Sudden drop in the barometric pressure
  • Extreme weather changes
  • Changes in blood sugar levels
  • Changes in menstrual cycle
  • Alterations in sleep schedule
  • Changes in eating habits
  • Changes in air pressure changes
  • Certain odors

Individuals who are prone to migraines should carefully monitor which changes occur before a migraine attack. This will help them avoid it or make necessary adjustments to counter or lessen the intensity of Chronic Migraine disorder.


The incidence and severity of Chronic migraines, according to doctors at the AAN (American Academy of Neurology), can actually increase due to an overuse of drugs used for their cure. Headaches can result and even worsen due to frequent intake of these medications. While pain relieving drugs medications can be useful for curing migraines, intake of the medicines for over two times a week can give rise to additional headaches. In such cases, headaches may begin in as little as two months after drugs are used for the first time.

Chronic Migraine Diagnosis

The diagnosis of Chronic Migraine syndrome is performed by medical examinations like blood tests, Computed Axial Tomography (CAT) scan and other diagnostic tests. The aim of these tests is to make sure that persistent migraines are not the result of any other medical factors. In some cases, physicians ask some migraine patients to consult neurologists for additional medical testing.

The International Headache Society has laid down the following criteria for a headache to be considered as Chronic Migraine (CM):

  • Headache, whether originating from tension or similar to migraine, should occur for 15 days or more per month or for a period of at least 3 months.
  • The patient should experience pain and other related migraine symptoms on less than or equal to 8 days every month. The symptoms may arise without aura. He or she should opt for treatment or experience relief prior to the expected maturation of symptoms.
  • The symptoms should arise even in the absence of any drug overuse.

The medical history of the patient, his or her lifestyle and dietary habits are also taken into consideration while making a proper diagnosis.

Chronic Migraine Treatment

There are two treatment options for sufferers of this condition. These are:

Natural Treatment

Keeping a journal is one way of natural treatment for patients of these headaches. The purpose of keeping a migraine journal is to keep track of sleep patterns, food intake, exercise, daily weather and menstrual cycle of the sufferer. This helps sufferers identify and avoid any changes in food, sleep or any other activity that might act as trigger factors for these headaches. In many cases avoidance of foods or conditions, which act as triggers, is effective enough to keep Chronic Migraine headaches away.

Medical Treatment

Medical treatment for this condition involves prescription medicines that are used to attempt prevention of the occurrence of migraines. These include

  • Antidepressants
  • Anti-seizure drugs
  • Beta-blockers
  • Blood pressure medicines

There also are many prescription drugs that can be used in the very early stages of a migraine. Some patients of CM headaches are prescribed both types of medicines. These help control the severity as well as frequency of the headaches.

Acute Chronic Migraine Treatment

Certain options for the treatment of acute cases of this condition include:

  • Ergotamines
  • Simple analgesics
  • Triptans
  • Non-steroidal anti-inflammatory drugs (NSAID)

Use of these curative agents should be restricted to 2 days or less every week. Failure to do this can increase risk for rebound headache by complicating treatment. Patients may possibly need detoxification in such cases.

Chronic Migraine Trigger Factors

Some common trigger factors for this condition include

  • Changes in diet
  • Sleep changes
  • Exercise
  • Changes in mental well-being
  • Beverages with alcohol or caffeine
  • Certain over-the-counter (OTC) medicines
  • Selected prescription medications
  • Some food items (as aforementioned)
  • Tobacco

Initial treatment options for these headaches should aim at controlling one or more trigger factors. Intake of oral trigger factors, such as caffeine and alcohol, should be limited to a minimum due to their possibility of increasing risk of headaches. Options for treatment can be further subdivided into preventive and acute pharmacotherapy.

Preventive pharmacotherapy concentrates on various classes of drugs, which include:

  • Antidepressants
  • Anticonvulsants
  • Beta-blockers
  • Calcium channel blockers

Botox injections may also be a possible requirement. Patients who begin new preventive therapy should remember that treatment may take one to two months to make a complete effect.

Chronic Vestibular Migraine

Vestibular migraine is a variation of migraine in which dizziness is the most predominant feature, rather than headache. Individuals suffering from this condition generally report of sudden, extreme dizziness that makes them unsteady while standing or walking. Some patients complain of a rocking or spinning sensation. They become sensitive to sound or light and suffer from nauseating symptoms that make them throw up. Such episodes can persist anywhere from minutes to hours. Chronic Vestibular Migraine is a type of migraine headache that persists for a longer period.

Chronic Vestibular Migraine Symptoms

In chronic cases of Vestibular Migraine, patients suffer from a continuous sense of instability. In many cases, sufferers are found to have a history of migraine headaches before vestibular migraine surfaces.

Some other symptoms of this disorder are:

  • Dizziness
  • Vertigo
  • Acute pain in the head

Chronic Vestibular Migraine Causes

Chronic Vestibular migraine is supposed to be an acquired genetic condition. The exact mechanism behind vestibular migraines is still unclear. However, the condition is believed to involve unusual excessive sensitivity (Hyperexcitability) in the stem of the brain that is partially or wholly coinciding with the vestibular structures. It is these structures that allow humans to keep the balance. Dizziness is caused by Hyperexcitability.

Chronic Vestibular Migraine Treatment

Frequent or chronic cases of vestibular migraines are usually treated with the aid of

  • Selective Serotonin Reuptake Inhibitor (SSRI), a type of antidepressant
  • Antiepileptic drugs
  • Daily calcium channel blockers (a kind of drug that reduces blood-pressure)

Acute attacks are generally cured with the help of

  • Triptan drugs
  • Anti-inflammatory medicines (that lead to a constriction of the blood vessels in the brain)
  • Anti-nausea agents

Some muscle relaxants may also help in controlling severe muscular symptoms resulting from this condition. Patients may also use other medicines like antidepressants and anti-epileptic drugs that can be bought from any leading drugstore. Sufferers of this disorder should not despair as the problem can be managed. There is availability of treatment options and the rate of recovery has a good prognosis.

Chronic Daily Migraine

It refers to a type of migraine headache that arises almost every day.

Chronic Daily Migraine Synonyms

It is also known by other names like:

  • Chronic Migraines
  • Transformed Migraines
  • Chronic Daily Headaches
  • Chronic Daily Headache Syndrome
  • Transformational Migraine
  • Chronic Daily Headache Evolved From Migraines

Chronic Daily Migraine Symptoms

The symptoms of this form of headache involve:

  • Nausea
  • Extreme sensitivity to light
  • Extreme sensitivity to sound

However, this condition is mainly characterized by a throbbing pain on one side of the head. The pain usually worsens while a patient is moving.

Chronic Daily Migraine Causes

Overuse of analgesics is the primary reason for the appearance of these types of headaches. It is also believed to be a result of other factors like

  • Constant stress
  • Hormonal imbalance
  • Genetics
  • Food items
  • Certain medications
  • Some types of beverages
  • Empty stomach
  • General malnutrition

Chronic Daily Migraine Diagnosis

The criteria for diagnosis of these types of migraines are the same as Chronic Migraines. These headaches need to occur 15 days or more in a month or for at least three months continuously to be considered as Chronic Daily Migraine (CDM). The symptoms should arise even without any overuse of drugs.

Chronic Daily Migraine Treatment

The medical treatment for this problem involves painkillers as well as a daily preventive drug such as Anticonvulsants, Antidepressants or blood pressure medications. Natural treatment for this problem requires the patient to keep a daily migraine journal that will help him or her identify foods, chemicals or any biological factors such as stress that can act as possible triggers for a migraine attack.

Chronic Migraine Prognosis

The prognosis of this condition has not been extensively studied. However, prognosis is supposed to be dependent on the remission or ceasing of the factor or factors causing the headaches. Many women make a total recovery after they have completely passed through a menopausal stage or pregnancy.

Headaches arising due to migraine typically improve once patients attain the age of 50 or 55. Both men and women show an improvement after 50 years of age. Symptomatic improvement for women coincides with achieving natural menopause. Both men and women can expect a progressive reduction in the frequency and severity of their Chronic Migraine headaches after the age of 55.

Total avoidance of food items or beverages, which act as trigger factors for these headaches, can also help patients make a fast recovery. Prognosis is very good in cases where there is a rapid identification and obliteration of causative factors. Prognosis is good, albeit temporary, in cases where medications are used.

Chronic Migraine Prevention

Prevention is the best way to get a Chronic Migraine relief. Unfortunately however, chronic headaches which arise on a daily basis do not respond well to preventive medications. This is due to factors like:

  • Overuse of medications
  • Failure in curing a correlated medical disease
  • Failure in stopping use of causative medicinal factors like antidepressants and cholesterol drugs
  • Failure in diagnosing rare causes like sinus abnormalities, environmental allergies and food allergies

It is best to stay away from trigger factors to avoid a case of chronic migraine headache.

If you suspect yourself or anyone in your family to be suffering from Chronic Migraine, get in touch with a doctor immediately. Proper diagnosis and treatment will help you get a quick relief from this highly discomforting syndrome.


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