When Tony and Emmy winner Kristin Chenoweth was 25 years old, she had her first migraine attack while performing with the Virginia Symphony.

“At first, I thought something must be wrong with the spotlight. I started getting what I now call, ‘kaleidoscope eyes,’ meaning I see flashes of light, and couldn’t see clearly,” she told Healthline. “I also got what felt like a brain freeze, like when you drink a slushie too fast, and the music sounded like it had been turned way up.”

She pushed through the performance until intermission but then fell to her knees with a pounding headache and she vomited on stage.

“I spent the whole intermission worrying about how I would get through the final 45 minutes of the concert,” said Chenoweth.

Somehow she found a way to perform until the end, but as soon as the curtain dropped, she collapsed. A doctor attended to her and informed her that she was having a migraine attack.

“I didn’t know where to go from there. I was confused, worried, and scared this would end my career,” Chenoweth said.

Symptoms of chronic migraine

In the years following her first migraine attack, Chenoweth began having them so frequently that she was diagnosed with chronic migraine.

Chronic migraine is defined by the International Headache Society (IHS) as headaches occurring on 15 or more days per month for more than 3 months, where at least 8 of those headache days have the following migraine features:

  • moderate or severe pain that’s often intense
  • pain on one side or both sides of the head
  • head pain that causes throbbing, pounding, or pulsating
  • pain that worsens with exercise or movement
  • head pain accompanied by nausea, vomiting, or light and sound sensitivity

To diagnose a migraine disorder, a doctor might start by performing a physical and neurological exam, or request other tests such as blood tests, MRIs, and CT scans to rule out any conditions that could cause migraine-like symptoms.

However, a diagnosis is often based on how many headache days you experience, rather than the amount of disability you have from them.

The American Migraine Foundation (AMF) recommends tracking your headache days and including all the days you have a headache no matter how severe or mild it is. Keeping a headache journal on paper or in an app can help you gather accurate information so your doctor can determine an appropriate diagnosis.

“In addition to when you have [a] headache, it is helpful to note when you are taking medications to treat these headaches so we can track that the medications are not being overused, and in addition any symptoms you may have noticed with the headache attacks,” Dr. Brian Plato, headache neurologist at Norton Neuroscience Institute, told Healthline.

Keeping track of your headaches will help determine if you experience episodic or chronic migraine.

Episodic migraine episodes can last for hours, yet they may not occur again for weeks or months, whereas chronic migraine attacks last longer and occur more often.

According to 2022 research in the journal Frontiers in Neurology, there were 1.1 billion episodic migraine cases in 2019.

Additional research has found that 17.1% of U.S. women and 5.6% of U.S. men have episodic migraine.

Common symptoms of migraine include:

  • headache
  • nausea
  • light and sound sensitivity
  • dizziness
  • sensory disturbances (called an aura)

While a headache is a symptom of migraine, Plato stressed that migraine is not just a headache, but rather a disabling neurological condition that often includes head pain.

“[But] you do not have to have [a] headache to have migraine. Many times, the non-headache symptoms — light/sound sensitivity, nausea, dizziness, trouble thinking, trouble speaking, vision changes, numbness — these symptoms sometimes can be more disabling than the headache,” he said.

Additionally, Dr. Salman Azhar, a neurologist at Lenox Hill Hospital, said a number of people who feel like they have recurring sinus headaches “actually have migraine headaches with sinus symptoms such as nasal congestion or watery eyes.”

Educating people that chronic migraine is more than just a headache is one of Chenoweth’s biggest struggles. She wants people to know migraine is serious.

“There have been times when I’ve been on the floor, unable to move, vomiting, and unable to go out on stage,” she said.

When migraine symptoms hit on the job, she channels courage and motivation from the people who came to see her.

“As a performer, I’m always thinking about that little girl in the audience who is in New York City to see a Broadway show for the first time. She deserves my 100% and I feel guilty if I am not able to give that to her,” said Chenoweth.

Despite all her best efforts, at times her migraine attacks are so severe that she has to miss performances and other events.

One memorable time she dealt with a migraine attack was the night she won her first Emmy Award in 2008.

“I couldn’t even celebrate because taking pictures and socializing was just too much. The last thing you want to do is let down your friends, family, and colleagues, but for many people with chronic migraine, that’s just the reality,” Chenoweth said.

While it’s tempting to try to power through migraine attacks, she noted that sometimes caring for herself requires taking time for herself.

“And for me, that’s the hardest part. I don’t want this next generation to feel like they always need to ‘tough it out’ either,” she said.

“It feels so freeing to talk about my condition. I have been able to build a support system around me that really understands what I’m going through,” says Chenoweth.

Genetics can play a role in your migraine risk

While having conditions such as depression, anxiety, bipolar disorder, sleep disorders, and epilepsy increase a person’s chances of developing migraine, so does having a family history of migraine.

The National Library of Medicine states that most people who experience migraine have family members who live with migraine. Women are also 3 times more likely than men to have migraine attacks.

As a child, Chenoweth witnessed her mother having migraine attacks but said having them herself gave her a new appreciation for what her mother went through.

“I think the biggest difference is that the management of migraine has changed so much, and I’m grateful to have found a chronic migraine treatment that works for me,” she said.

Over the years, she tried several treatments before finding a treatment plan that works for her, which includes FDA-approved BOTOX for chronic migraine every 12 weeks.

BOTOX works as a preventive medication to help reduce the frequency and severity of headache attacks. The treatment has been shown to reduce the number of headache days per month on average by about 50%, according to the AMF.

Chenoweth said the injections take 10 minutes and feel like “tiny pinches” on the skin.

However, there are serious side effects that can occur with BOTOX, such as difficulty swallowing, speaking, or breathing, eye problems, muscle weakness, neck pain, and headache, so it’s important to talk with a doctor about whether it’s an appropriate and safe treatment for you.

To empower other people living with chronic migraine to talk with their doctor about how to manage the condition, Chenoweth partnered with AbbVie on the Center Stage with Chronic Migraine program.

“[This] felt like a timely and meaningful way to bring this debilitating disease front and center stage [for] others who live with chronic migraine,” she said. “It’s so important to find a doctor that you can be open and honest with, someone who listens carefully to your needs and is willing to work with you to find a treatment plan.”

In addition to BOTOX, she said learning what triggers her migraine attacks helps her manage them. Stress, flying, working too many hours, and diet are all culprits.

“I do try to manage them — as much as possible, of course — I’m on a plane a couple times a week these days! Bright lights can also be a trigger, so it may look funny but I wear sunglasses everywhere. Additionally, I avoid alcohol and eat a low-salt diet,” she said.

While triggers vary from person to person, the National Library of Medicine reports that common triggers for migraine include:

  • stress or anxiety
  • hormonal changes in women
  • bright or flashing lights
  • loud noises
  • strong smells
  • certain foods, especially caffeine or tobacco

If you identify a single trigger that causes migraine symptoms, avoiding that trigger makes sense. However, Plato said that often it’s a combination of triggers that leads to migraine attacks.

“The reality is that for most people, it is A + B + C together that results in the migraine attack,” he said.

“Over the years, I’ve learned how powerful it is to be open about your disease … I hope that by sharing my experience with chronic migraine, I can inspire others to manage this disease,” says Chenoweth.

Other treatments for migraine

In 2018, the FDA approved anti-CGRP migraine treatments to prevent both chronic and episodic migraine.

These medications work by blocking the protein calcitonin gene-related peptide (CGRP), which can cause inflammation and pain in the nervous system of people who experience migraine.

It can be self-administered with injections monthly or, in some cases, quarterly. The AMF reports that there’s evidence that anti-CGRP migraine treatments can reduce the number of migraine days by 6–8 days per month for people with chronic migraine.

“These medications have significantly changed the landscape of what tools we have available to treat migraine. But perhaps more importantly, what these medications have done is to help change the conversation about what migraine really is — it is a real neurological disease that consists of the brain and nerves being activated during these attacks caused by identified neuropeptides,” said Plato.

Another family of medications known as gepants also target the same peptide, but are taken orally, “[and] depending on the gepant, can be used as rescue treatment … or prevention,” said Azhar.

He added that the medication lasmiditan (Reyvow) targets serotonin receptors in the brain to stop a migraine attack as it’s occurring.

Other treatments that may be prescribed to prevent chronic and episodic migraine include:

  • beta-blockers like propranolol
  • calcium channel blockers
  • antidepressants
  • anticonvulsants or epilepsy medications

Once migraine attacks occur, there are acute medications that can help stop the migraine or ease its symptoms, including over-the-counter and prescription treatments such as ibuprofen, acetaminophen, sumatriptan, and more.

With acute treatments, it’s important to keep an open dialogue with your doctor and limit these medications since medication overuse for headaches can be unsafe.

In addition to medication, there are self-care practices that may help when symptoms strike, like staying in a quiet, dark room with your eyes closed, putting a cool cloth or ice pack on your forehead, or drinking liquids.

Lifestyle changes, such as managing stress with exercise and relaxation techniques, maintaining a moderate weight, and logging what foods, medicines, and environmental triggers you have, can also help in preventing them.

Raising awareness of chronic migraine

Because chronic migraine is an invisible illness, Chenoweth said living with the condition has taught her to realize other people may be going through challenges that aren’t apparent.

“It’s reinforced the impact of compassion for people around [me],” she said.

Sharing her story also ignited self-compassion and self-advocacy.

“When I am working with a team for a prolonged period of time, I open up about my chronic migraine diagnosis and my plan to avoid triggers,” she said. “It feels so freeing to talk about my condition. I have been able to build a support system around me that really understands what I’m going through.”

She hopes her story empowers others to speak out and take control of their disease.

“Over the years, I’ve learned how powerful it is to be open about your disease … I hope that by sharing my experience with chronic migraine, I can inspire others to manage this disease,” she said.

Most importantly, she wants those living with migraine to know: “You are not alone.”