Migraine affects roughly 35 million people, or about 12 percent of the U.S. population. Typically, migraine affects more women than men. Yet, up to half of those with migraine don’t have a diagnosis. Continue reading to learn more about severe or chronic migraine and treatment options.
The symptoms of severe or acute migraine include pain, which is usually severe and often disabling, as well as intense throbbing. Some people experience nausea, vomiting, or extreme sensitivity to noise or light during attacks. Episodes of severe migraine may last from 4 hours to 3 days.
Severe migraine may occur with or without aura. Aura refers to a perceptual disturbance. Examples include experiencing nonexistent smells, lights, or sounds. Migraine is often considered severe when pain, nausea, or other associated symptoms force a person to avoid normal daily activities.
Also, migraine is classified as severe if the person affected has a history of two to five similar episodes. Migraine is most common among people
Chronic migraine occurs at least 15 days a month, for more than 3 consecutive months. This type of migraine can cause a substantial
Chronic migraine treatment typically involves lifestyle and trigger management, medications, and preventive measures. Managing your diet, ensuring you get enough sleep, and avoiding your migraine triggers whenever possible is a start, but typically your doctor will recommend medications to manage pain and other symptoms.
Numerous drugs are available to treat migraine. Over-the-counter medications, such as aspirin, ibuprofen, and acetaminophen, can be helpful in treating mild to moderate migraine episodes. For moderate to severe migraine, however, triptans may be recommended. Triptans, which were created to treat acute migraine symptoms, may be taken orally or via a nasal spray.
Here’s a list of commonly prescribed medications in the triptan family:
- sumatriptan (available in oral form, injectable form, or nasal spray)
- zolmitriptan (available in oral form or nasal spray)
Triptans are most effective when used to treat a migraine episode that has not yet progressed to a severe stage.
Research around the use of supplements to treat migraine is ongoing, but feverfew, magnesium, riboflavin, and coenzyme Q10 may help. Ultimately, a
At this time, onabotulinumtoxin A (Botox) is a popular preventive treatment for chronic migraine approved by the Food and Drug Administration (FDA).
Anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies are also used to treat chronic migraine. Anti-CGRP treatments are also called CGRP, CGRP inhibitor, and CGRP antagonist treatment. These include:
- eptinezumab (Vyepti)
- fremanezumab (Ajovy)
- galcanezumab (Emgality)
- atogepant (Qulipta)
- erenumab (Aimovig)
Most CGRP migraine treatments are taken by injection. Atogepant is the first, and so far only, FDA-approved oral CGRP for the treatment of migraine.
Virtually everyone gets ordinary tension headaches. Tension headaches typically cause a dull pain, as if a tight band is squeezing the head. Triggers may include:
- muscle tension in the neck and scalp
- caffeine withdrawal
- too little sleep
Tension headaches usually respond to treatment with common over-the-counter pain relievers.
A cluster headache is another less common type of headache. Cluster headaches affect men more often than women. The headaches are characterized by sudden severe pain behind or around the eye, on one side of the head. Pain peaks within 10 minutes but can last 15 minutes to 3 hours.
Migraine, which is considered a neurological disorder, and migraine episodes are distinct from tension or cluster headaches. When migraine is chronic, it can be very disruptive to a person’s life.
Some people with migraine report warning symptoms. This is known as migraine with aura. Warning symptoms may include blurred vision, seeing “stars,” or other odd sensations like unpleasant smells before the onset of an attack. Some may even experience slurred speech or other language difficulties. Temporary loss of vision in one eye has also been reported.
Aura may occur from 10 minutes to 1 day before the onset of a migraine episode. In some cases, a person may experience an aura without a migraine episode. Migraine with aura tends to be less severe and disabling than migraine without aura.
A number of factors are known to trigger the onset of migraine episodes.
- fluctuating hormone levels
- stress or anxiety
- fermented and pickled foods
- cured meats and aged cheeses
- fruits such as bananas, avocados, and citrus
- skipped meals
- too little or too much sleep
- bright or strong lights
- changes in atmospheric pressure due to shifting weather
- alcohol use
- caffeine withdrawal
Migraine results from a complex cascade of abnormal events in the brain, something researchers are still trying to fully understand. One thing scientists do know: The abnormal activity originates in the body’s largest cranial nerve, the trigeminal nerve. Changes within this cranial nerve quickly spread to a network of smaller nerves. These nerves form a web throughout the delicate outer lining of the brain, known as the dura mater.
Within as little as 10 minutes after a migraine episode begins, pain-sensing nerves in this network undergo molecular changes. This causes them to become hypersensitive to pressure. This hair-trigger response creates throbbing pain as blood pressure naturally rises and falls with each heartbeat.
Also, certain arteries dilate and blood flow is altered, causing the release of pain-producing chemicals. You may experience some of these changes even after an attack has passed.
Brain messenger chemicals, dopamine and serotonin, are also believed to play a role in developing migraine.
Another theory suggests that migraine may be related to the brain’s temperature. If it’s too high or too low, a migraine attack may occur as the body’s defensive response to temperature fluctuations. In addition, a
Scientists believe there’s a
In general, a migraine episode may appear as a severe headache. Chronic migraine is the presence of an episode at least 15 days a month for more than 3 consecutive months. It’s possible that some days the episode is not so severe and on others it is quite painful, leading to a loss in productivity and quality of life.
If you think you have chronic migraine, you should speak with your doctor so they can help you decide on a course of treatment.