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What Are Chronic Migraines A Symptom Of

Take A Detailed History

Living with Chronic Migraines (symptoms, triggers, etc.)

Accurate history taking is vitally important in the diagnosis of migraine. It is important to give patients time to describe their attacks fully , and also to clarify the history with specific questions aimed at filling out the gaps in what the patient has told you spontaneously. The diagnosis of migraine lies in the history, and that the purpose of examination is primarily to look for other problems that may be exacerbating an underlying tendency to migraine. This may in most cases be restricted to fundoscopy, inspection and palpation of the head and neck structures, and a brief screening cardiovascular and neurological examination, unless, on the basis of the history, serious intracranial or systemic pathology is suspected.

It is then useful to ascertain what treatments, current and previous, have been tried, and at what point these treatments are taken. Patients should be asked to bring a list of medications tried in the past, including doses, and be asked why these treatments were abandoned . The use of alternative or complementary therapies should also be sought.

While superficially there seems to be a lot of information required, it is almost invariably the case that patients will volunteer much of this information without being specifically asked, and it usually does not take too much time to fill out the gaps if a structured approach to the history taking is followed. If there is uncertainty, then encouraging the patient to keep a headache diary can be very useful.

What Is Chronic Migraine

Chronic migraine is defined as having headache on at least 15 days per month, with eight of these having migraine symptoms, for at least three months. People who have fewer headache days with migraine symptoms have episodic migraine.

If you have chronic migraine your symptoms may include:

  • frequent headache
  • increased sensitivity to light, sound or smells
  • nausea
  • vomiting .

Other symptoms include aura , dizziness and vertigo .

What Preventive Treatments Are Used For Chronic Migraine

Headache specialists use the same preventive treatments for chronic migraine as for episodic migraine. However, some preventive treatments have been specifically studied and shown to be effective for chronic migraine. The first treatment that was specifically studied and FDA approved for chronic migraine rather than episodic migraine was onabotulinumtoxinA or Botox.

Other treatments are effective for chronic migraine but arent specifically FDA approved for this indication. One of those is topiramate or Topamax. The monoclonal antibodies targeting CGRP were studied for both chronic and episodic migraine, and shown to be effective for both. Those are the ones for which there’s evidence for preventive efficacy in chronic migraine.

Andrew Charles, Patricia Pozo-Rosich. Targeting calcitonin gene-related peptide: a new era in migraine therapy. Published Online October 23, 2019

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Chronic Migraine When Someone Has More Than 15 Headache Days Per Month Affects 35% Of The Us Population

Migraine is a common and disabling condition reported in approximately 12% of the population. In the Global Burden of Disease Study in 2019, migraine was found to be the third highest cause worldwide of years lived with disability. Migraine attacks sometimes increase in frequency over time. Headache experts divide this process of transition into three distinct states:

  • No migraine
  • Episodic migraine
  • Chronic migraine

Chronic migraine occurs in 35% of the U.S. population. Its possible for someone with episodic migraine to develop chronic migraine. In addition, studies suggest that about 3% of people with episodic migraine will transition to chronic migraine each year.

Read more to learn about the symptoms, risk factors, diagnosis and treatment of this condition.

The Costly Impact Of Chronic Migraines

Pin by Nia on Chronic Migraines

Patients suffering from migraine pain can feel the effects not only physically, but also through the loss of work, family time and personal day-to-day pleasures.

Migraines cost American businesses over $13 billion annually. Many sufferers will miss more than a week of work every year due to their migraines alone. A serious impairment in the ability to perform daily tasks is reported by 39% of migraine patients. More than half experience a more complete loss of function and require bed rest to deal with the pain. Fewer than one in ten migraine patients do not suffer from this disabling effect.

Patients who report intense, frequent and debilitating headache pain are often found to have a migraine disorder. At National Headache Institute, our specialty is treating migraines effectively in cases where patients have been unable to obtain relief from prior treatments.

Migraine headache disorders are as many as three times more common in women than in men. There appears to be a link between fluctuating female hormones and the occurrence of migraine symptoms. These hormonal changes are probably responsible for menstrual migraines. Upwards of 60 percent of women suffering from migraines report an increased onset during their menstrual cycle.

The majority of people with migraine disorders are not receiving medical care. This fact contributes to misdiagnoses, ill-advised self-prescribed treatments and the overuse of medication that can lead to increased symptom frequencies.

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How Is Chronic Migraine Diagnosed

Your doctor will take a detailed medical history. The doctor will ask about:

  • Your pattern of migraine pain, including when and how migraines begin if they are episodic or continuous how long the migraine lasts if there are any triggers or factors that make the migraine worse.
  • Your description of the pain, including its location, sensation, and severity.
  • Other symptoms that accompany the pain, such as auras, lack of energy, stiff neck, dizziness, changes in vision or in senses, and nausea/vomiting.
  • Your current and previously tried treatments, including when the medications are taken, dosages, outcome and side effects and use of alternative or complementary therapies.
  • Your medical history including other health problems , family history of headache, current non-headache medications, and lifestyle choices .

Functional Brain Alterations In Chronic Migraine

In addition to central sensitization, it is likely that the activation and sensitization of the trigeminal pathway and related pain circuits within the brain become persistent with disease chronification. This may further contribute to the structural and functional reorganization of pain-related circuits in chronic migraineurs, increasing susceptibility to the development of more frequent attacks, thus bypassing the interictal phase in most instances .


While existing evidence from episodic migraine studies indicates that the PAG may play a distinctive role in migraine pathogenesis , further investigations are necessary to delineate whether the PAG is involved specifically in migraine or more generally in pain conditions. Nonetheless, these progressive episodic migraine studies have paved the way for chronic migraine research by delineating the potential role of the PAG in underlying mechanisms of chronic migraine.


Cerebral Cortex

These observations in functional changes suggest that chronic migraineurs exhibit aberrant pain processing due to altered descending pain modulation . Determining if underlying neural alterations are analogous to both episodic and chronic migraineurs or specifically involved in migraine chronification remains elusive and requires further research .

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What Causes Chronic Migraine

Its not fully understood what causes chronic migraine.

For a lot of people chronic migraine develops gradually with migraine attacks becoming more frequent over time. Around 2.5 out of 100 people with episodic migraine will develop chronic migraine each year. For some people chronic migraine will go into remission within 2 years of becoming chronic.

The pattern of chronic migraine will vary depending on your individual circumstances. For some people it may return to episodic migraine, some people find it stays the same and others find that it gets worse.

There are a number of medical conditions that can increase your tendency to have migraine. These include:

Managing these can help with managing migraine and the effectiveness of migraine treatment.

Syndromes That May Be Associated With Migraine

Treating Chronic Migraine: Remember the Fundamentals

Certain disorders occur more frequently among people with migraine or people, usually children, at a higher risk of developing migraine:

Cyclical Vomiting Syndrome In cyclical vomiting syndrome, an individual experiences attacks of severe nausea and vomiting lasting an hour or more for up to 10 days at a time. Between attacks, which occur on a regular cycle, the person has no symptoms of nausea or vomiting.

Abdominal Migraine

Benign Paroxysmal Vertigo In this syndrome, otherwise healthy children experience recurrent brief attacks of vertigo that come on without warning and resolve spontaneously without loss of consciousness. During the attacks, a child may have nystagmus , impaired balance or coordination , vomiting, pale skin, and fearfulness.

Benign Paroxysmal Torticollis Occurring in infants and small children, this syndrome causes the head to tilt to one side, with or without slight rotation, and stay tilted for minutes to days before spontaneously resuming its normal position. During the attack, the infant or child may be pale and irritable, seem uncomfortable or generally unwell, vomit, or in older children, have impaired balance or coordination.

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Migraine And Vascular Disorders

Migraine and ischemic strokes reportedly occur in 1.4-3.3 per 100,000 population and account for 0.8% of total strokes. Milhaud et al showed that in young patients with active migraine who had suffered ischemic stroke, risk factors such as patent foramen ovale, female gender, and oral contraceptive use were much more likely to be present posterior circulation stroke was characteristic. Surprisingly, older patients characteristically lacked vascular risk factors .

Even in patients older than 45 years, women with migraine are more likely to suffer from ischemic stroke.

Migraineurs, male and female, have a 2.5-fold increased risk of subclinical cerebellar stroke and those with migraines with aura and increased headache frequency are at the highest risk.

Migraineurs also have a higher incidence of adverse cardiovascular profiles , and they are more likely to be smokers, have a family history of early heart attacks, and have an unfavorable cholesterol profile. The odds of an elevated Framingham risk score of coronary artery disease are doubled with migraine with aura, and women who have migraine with aura are more likely to be using oral contraceptives.

These findings have been confirmed in a population-based study by Bigal et al. Similarly, a study by Gudmundsson et al found that men and women who have migraine with aura are at a higher risk for cardiovascular and all-cause mortality than are those without headache.

Foods And Food Additives

Certain foods and beverages, particularly alcoholic beverages, can be triggers. The flavor enhancer monosodium glutamate can also be a trigger, as can caffeine.

Foods containing the amino acid tyramine have been associated with migraine onset. Examples include aged cheese, smoked fish, chicken livers, figs, certain beans, and red wine.

The nitrates in cured meats such as bacon, hot dogs, salami, and other lunch meats are a trigger for some.

Research has also suggested that the artificial sweeteners aspartame and sucralose can be triggers.

And for some people, fruits such as avocados, bananas, and citrus as well as some nuts and seeds can trigger migraine.

Missing or skipping meals can trigger attacks, too.

One approach to discovering migraine food triggers is to try an elimination diet, in which certain foods are eliminated from the diet for a few weeks, then reintroduced one at a time to see whether a migraine attack occurs.

However, a given food does not always trigger a migraine attack sometimes another trigger, such as a change in the weather, also has to be present for an attack to take place. Or a certain amount of food has to be consumed before it has an effect, according to an article published in June 2020 in the journal Nutrients.

For that reason, most experts recommend consulting your physician before trying an elimination diet for migraine and, if you do decide to try it, working with a registered dietitian to maintain good nutrition.

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What Happens During A Migraine

Every migraine begins differently. Sometimes people get a warning that a migraine is on its way. A few hours or even days before the actual headache, people might feel funny or “not right. They might crave different foods, or feel thirsty, irritable, tired, or even full of energy. This is called a “premonition.”

Some people get auras. These are neurological symptoms that start just before the headache and last up to an hour. An aura is different in every person, but it often affects vision. For example, a person might:

  • have blurred vision
  • see spots, colored balls, jagged lines, or bright flashing lights
  • smell a certain odor
  • feel tingling in a part of their face

Once the headache starts, light, smell, or sound may bother people with migraines or make them feel worse. Sometimes, if they try to continue with their usual routine, they may become nauseated and vomit. Often the pain begins only on one side of the head, but it might eventually affect both sides. Trying to do physical activities can make the pain worse.

Most migraines last from 30 minutes to several hours some can last a couple of days.

Preclinical Studies Of Chronic Migraine

Migraine Symptoms: The stages of a migraine

Although advancements in understanding chronic migraine pathophysiology and the development of novel therapeutics can potentially be achieved through preclinical studies, current animal models of chronic migraine remain limited. There are currently several techniques designed to induce headache-like pain in rodents, however, due to the complex nature of migraine, replication of the entire chronic migraine condition remains elusive. Since headache frequency is the key phenotypic difference of chronic migraine, repeated dural applications of inflammatory soup, intravenous infusions of glyceryl trinitrate and repetitive administration of acute migraine abortive treatments such as triptans to stimulate medication overuse headache have been most widely implemented to model chronic migraine .

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Migraine And Other Vascular Disease

People who suffer from migraine headaches are more likely to also have cardiovascular or cerebrovascular disease . Reliable evidence comes from the Women’s Health Study, which found that migraine with aura raised the risk of myocardial infarction by 91% and ischemic stroke by 108% and that migraine without aura raised both risks by approximately 25%. Migraines during pregnancy are also linked to stroke and vascular diseases. A 2017 analysis of the Women’s Health Study found that women who experience migraine headaches, particularly migraine without aura, may be at increased risk for hypertension. Compared with women without a history of migraine, those who experienced migraine with aura had about a 9% increased risk for hypertension while those who experienced migraine without aura had about a 21% increased risk.

Migraine with aura for women in midlife has a statistically significant association with late-life vascular disease in the cerebellum. This association is not seen in migraine without aura.

Summary Of Chronic Migraine

Migraine is considered chronic when people have 15 or more headache days per month, with at least 8 of those days meeting criteria for migraine. Chronic migraine can be a very disabling condition. Development of chronic migraine has been associated with a number of potentially treatable risk factors. Chronic migraine treatment should primarily focus on prevention through use of medication and non-medication preventive strategies as well as addressing identified risk factors.

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Alternative Remedies For Treating Migraines

Nontraditional therapies might help with chronic migraine pain.Acupuncture. Clinical trials have found that acupunctureAcupuncture. Clinical trials have found that acupuncture may be helpful for headache pain. In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin at defined points. Biofeedback. Biofeedback appears to be effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.Cognitive-behavioral therapy.

Cognitive-behavioral therapy may benefit some people with migraines. This type of psychotherapy teaches you how behaviors and thoughts affect how you perceive pain.

When To Get Medical Advice

Causes and resolution of chronic headaches

You should see a GP if you have frequent or severe migraine symptoms that cannot be managed with occasional use of over-the-counter painkillers, such as paracetamol.

Try not to use the maximum dosage of painkillers on a regular or frequent basis as this could make it harder to treat headaches over time.

You should also make an appointment to see a GP if you have frequent migraines , even if they can be controlled with medicine, as you may benefit from preventative treatment.

You should call 999 for an ambulance immediately if you or someone you’re with experiences:

  • paralysis or weakness in 1 or both arms or 1 side of the face
  • slurred or garbled speech
  • a sudden agonising headache resulting in a severe pain unlike anything experienced before
  • headache along with a high temperature , stiff neck, mental confusion, seizures, double vision and a rash

These symptoms may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible.

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What Should I Do When A Migraine Begins

Work with your doctor to come up with a plan for managing your migraines. Keeping a list of home treatment methods that have worked for you in the past also can help. When symptoms begin:

  • If you take migraine medicine, take it right away.
  • Drink fluids, if you don’t have nausea during your migraine.
  • Lie down and rest in a dark, quiet room, if that is practical.

Some people find the following useful:

  • A cold cloth on your head
  • Rubbing or applying pressure to the spot where you feel pain
  • Massage or other relaxation exercises

What Are The Symptoms Of A Migraine

Individual migraines are moderate to severe in intensity, often characterized by a throbbing or pounding feeling. Although they are frequently one-sided, they may occur anywhere on the head, neck and face or all over. At their worst, they are typically associated with sensitivity to light, noise and/or smells. Nausea is one of the most common symptoms and it worsens with activity, which often results in patient disability. In many respects, migraines are much like alcohol-related hangovers.

Migraine pain can be felt in the face, where it may be mistaken for sinus headache or in the neck, where it may be mistaken for arthritis or muscle spasm. Complicating the diagnosis of migraine is that the headaches may be accompanied by other “sinus like” symptoms, including watering eyes, nasal congestion and a sense of facial pressure. Most patients who think they have sinus headache in fact have migraines.

In up to 25 percent of patients, the migraine headache pain may be preceded by an aura, a temporary neurological syndrome that slowly progresses and then typically resolves just as the pain begins. While the most common type of migraine aura involves visual disturbances , many people experience numbness, confusion, trouble speaking, vertigo and other strokelike neurological symptoms. Some patients may experience auras without headaches.

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