Images of Chronic Migraine
Chronic migraine is defined as daily or nearly daily headaches 15 or more days per month for more than 3 months. It is also called transformed migraine or chronic daily headache by some. Additionally:
- The affected person has suffered at least 5 prior migraine attacks.
- Daily or almost daily headaches that resemble tension-type headaches develop that include pain on both sides of the head that does not throb, is moderately intense, and is not made worse by physical activity. Additionally, these symptoms are experienced for 8 or more days a month for at least 3 months, or other headache symptoms are experienced that require the use of migraine-stopping medications.
- There may or may not be a long history of taking medications to relieve headaches (although it is more likely that chronic migraine has been caused by migraine that has progressed, especially when the migraine has not been treated effectively, than caused by overuse of medications).
- Stiff neck and a high fever associated with headache
- Sudden onset of a severe headache
- Loss of motor function, the ability to think clearly, or convulsions associated with headache
- Head injury
- Increased intensity and/or frequency of headaches
Who's at risk?
Those who suffer from chronic migraine usually have had migraines in the past with usual symptoms (nausea, vomiting, sensitivity to light and sound, headache that gets worse with activity. Chronic migraine is more common in women who have had migraine without what is known as visual aura. Visual aura is a problem with vision that leads in to the headache. There are many kinds of visual aura, but common experiences include floating lines, jagged shapes, flashing lights, or dark patches.
Usually, adults with chronic migraine have fewer "traditional" migraine attacks as part of their headache problem, while teenagers with chronic migraine are often bothered by the more traditional migraines as described above. Some reasons for getting chronic migraine include both too little treatment of migraine, and, conversely, too much treatment of migraine, particularly too much ibuprofen or medicines that contain caffeine. Other factors that can cause regular migraine to progress into chronic migraine are being overweight, too much stress, and snoring.
Signs and Symptoms
People who have migraine and develop chronic migraine notice a change in symptoms over months to years, during which normal migraine symptoms become less intense but the headaches become more frequent. Normal migraine symptoms can include headache as well as dark spots in vision, shimmering distortion at the edges of vision, dizziness, problems concentrating, trouble finding words, weakness, numbness, or tingling. Daily or almost daily headaches that resemble tension-type headaches develop that include pain on both sides of the head that does not throb, is moderately intense, and is not made worse by physical activity. In this new type of headache, now called chronic migraine, full migraines still occur in addition to the milder but daily headaches.
Please see Common and Classical Migraine via the VisualDx Disease List for self-care ideas to help with traditional migraine symptoms. Some things you can do specific to the chronic migraine aspect of this type of headache are to avoid over-the-counter medications and caffeine because part of the problem can be overuse of these medicines (also see Medication Overuse Headache). More often, the chronic migraine is thought to be a progression of "traditional" migraines that have been undertreated. Therefore, paying very close attention to your normal migraine treatment can be helpful. Joining a discussion group, either in person or online, can give you some ideas and support for managing the pain. Some things you can do include:
- Improve sleep habits
- Regular exercise
- Yoga or stretching
- Massage therapy
- Relaxation techniques or exercises
When to Seek Medical Care
People with chronic migraine often come to neurologists or headache specialty clinics because they notice that their headaches are more frequent, even if milder, and that their usual migraines are continuing. However, call your doctor right away for any headache if:
- You develop new symptoms not typical of prior headaches.
- An unusually severe headache occurs.
- You pass out or lose time.
- Your headache lasts an unusually long time.
- Headache awakens you from sleep.
- Fever and neck pain or stiffness are present.
Treatments Your Physician May Prescribe
It can take a long time, sometimes years, before you and your doctor(s) can break the cycle of chronic migraine. Many things in a person's daily regimen and lifestyle can influence and maintain chronic migraine. You and your doctor will want to look into:
- Anxiety and depression.
- Physical and emotional dependence.
- Physical/lifestyle (eg, obesity, snoring, diet, poor sleep habits).
- Chronic medication overuse/misuse.
- Formal referral for relaxation therapies/hypnosis/biofeedback.
- Referral to a sleep expert.
- Cognitive-behavioral therapy – talk therapy with a trained counselor to help identify stressors and develop coping strategies to minimize symptoms.
- Counseling and treatment for depression and/or anxiety.