Episodic vs. chronic migraine
Migraines are a deeply painful, often debilitating form of headache. People who experience migraines often require prescription medication or medical treatment to cope with their symptoms. A simple over-the-counter headache pill is rarely effective for treating migraine.
Migraines can be episodic or chronic. A typical episodic migraine (EM) can linger for hours. Then, several weeks or even months may pass between migraine episodes. Chronic migraines (CM), on the other hand, last longer and occur more frequently.
According to an American Migraine Prevalence and Prevention (AMPP) study,
Symptoms of a chronic migraine occur at least 15 days in each month and for at least three consecutive months. A chronic migraine must also involve two of the following migraine characteristics for a minimum of eight days in a month:
- causes moderate to severe pain
- predominantly affects one side of the head
- causes a throbbing, pulsating sensation in the side of the brain affected by the headache
- begins or is made worse due to routine physical activity, such as walking or cleaning
Migraines are not understood well by doctors and researchers. Possible causes have been identified, but definitive answers have not yet been discovered. Some theories as to what causes migraine include:
Central nervous system disorder: An underlying neurological condition might trigger chronic migraines.
Chemical imbalances: Proper brain function requires that all chemicals are evenly matched and all nerve pathways are clear. In the event any of these things are interrupted, migraine headaches may occur.
Genetic factors: If a close family member, such as a parent or sibling, has experienced migraine headaches, your chances of having migraines increases.
Vascular irregularities: Problems with the shape, size, or blood flow in vessels to or inside your brain may cause migraine headaches.
In some cases, chronic migraines may be an underlying symptom of another serious condition. Conditions that could cause chronic migraines include:
- traumatic brain injury
- inflammation or other problems with blood vessels in the brain, including stroke
- infections such as meningitis
- brain tumors
- intracranial pressure that’s too low or too high
When your doctor diagnoses you with chronic migraine, they’ll likely run tests to rule out these conditions.
Migraine triggers are different from migraine causes. People who are susceptible to migraines may find that certain situations, behaviors, or environments set off a new migraine episode. These factors are called triggers.
Triggers are different for each person. They may affect the same person differently each time they’re exposed to them, too. For people with chronic migraines, avoiding common migraine triggers may help reduce the likelihood of a flare-up of symptoms.
Common triggers for migraines include:
Anxiety and stress: People who have a history of migraine may find that painful headaches flare up during times of increased stress and anxiety.
Bad posture: How you sit may affect how you feel. Poor posture can reduce blood flow through your neck. This reduced blood flow may also trigger a migraine headache.
Caffeine use and abuse: Caffeine is a stimulant that may trigger a migraine episode. High-sugar sodas or drinks that contain caffeine can also trigger migraines.
Certain food and drink: Salty, spicy, and aged foods (such as cured meats and cheeses), and artificial sweeteners may be triggers. Monosodium glutamate (MSG) is a common food preservative that may trigger migraine headaches.
Hormones: Both episodic and chronic migraines are more common in women than in men. This may be because women experience regular hormonal changes as a result of menstruation. Women also experience significant hormone shifts before and during menopause. Hormonal medications, including birth control, can also trigger CM.
Medications: Vasodilators affect your vascular system (blood vessels). A vascular problem can trigger a migraine or make one worse. Because vasodilator drugs affect your blood vessels, they may trigger CM.
Headache medication: If you take over-the-counter headache medication more than three days each week or more than nine days in a month to treat your migraines, you may experience rebound migraines. Your doctor can help advise the best way to treat your migraines with medication.
Sensory stimulation: Flashing lights, loud music, and strong odors may trigger a migraine headache episode.
Sleep difficulties: Not getting enough routine sleep and getting too much sleep may both trigger a chronic migraine episode.
Weather: Shifts in temperature, humidity, and barometric pressure can affect your migraine status.
Treating chronic migraines may involve a mix of medications, lifestyle changes, and alternative remedies.
If you’re experiencing chronic migraines, your doctor will likely recommend that you take a prescription medication. Depending on your condition, you may be given medication that you take as a migraine sets in or that you take daily to prevent or lessen the severity of migraine attacks.
Triptan medications like almotriptan and eletriptan are acute migraine medications that are taken early on in a migraine attack to lessen the severity. You may also be prescribed antidepressants and antiseizure medications to reduce migraine activity.
Certain lifestyle changes can also help prevent migraines. Reducing stress and increasing relaxation can help prevent migraines in many people. Mindful meditation can help with this.
Alternative remedies that may be used to help treat migraines. These include massage, acupuncture, and increased B-2 vitamins. Biofeedback is another type of alternative remedy that may help prevent migraines. This teaches you how to relax certain muscles to reduce headaches.
People with chronic migraines are at a higher risk of complications such as:
- sleep disturbances
- related physical or psychological problems
The risk for these complications and conditions rise with the frequency of the migraines.
If you’re experiencing migraines for the first time or with increased severity or frequency, talk to your doctor. You can see your general practitioner, who may refer you to a neurologist or headache specialist. If you start experiencing any new symptoms along with a migraine, you should also call your doctor.
A sudden or unusual migraine can be a symptom of a medical emergency. If a sudden, severe headache comes on with the following symptoms, seek emergency medical attention immediately:
- severe vomiting and nausea
- shortness of breath, especially combined with a fever, rash, and stiff neck
- weakness, dizziness, or loss of balance
- numbness or tingling throughout the body
- blurry vision, double vision, or blind spots
- headache after a head injury
- personality changes, inappropriate behavior, or trouble with speech