Chronic migraine is more than just having very bad headaches. Migraine symptoms can make it difficult — or impossible — to do anything other than find a dark, quiet room until the migraine is over. Treating this condition focuses on reducing the frequency and severity of migraines, making them less disruptive and more treatable.
Chronic migraine is a condition where you have frequent or long-lasting episodes of headaches and migraines. With chronic migraine, your symptoms can shift daily (or even hour to hour). That can make it hard to tell where one migraine or headache ends and another begins.
IMPORTANT: A migraine isn’t just a bad headache. While the International Classification of Headache Disorders definition of chronic migraine includes both headaches and migraines, they aren’t the same.
Headaches are typically unpleasant and disruptive but aren’t severe enough to affect whether or not you can go about your usual routine or activities. The most common type is tension-type headache (TTH). The main symptom of TTH is pain that affects your head or face, but not your brain.
Migraines affect your brain directly, which is why they’re so severe. It’s common for the symptoms to be severe enough to disrupt your routine and activities. Trying to go about your life as you would under ordinary circumstances can feel unbearable when you have a migraine.
Migraines are relatively common, affecting around 12% to 15% of the population worldwide. Chronic migraine is less common, and experts estimate 1% to 2.2% of people worldwide have this condition.
Chronic migraine is more likely to affect women and people assigned female at birth (AFAB). Between 1.7% and 4% of women and people AFAB have chronic migraine, compared to 0.6% to 0.7% of men and people assigned male at birth.
Migraines often start around puberty and usually become less frequent as you age. In women and people AFAB, migraines rarely happen or stop entirely after menopause.
Chronic migraine symptoms are the same as those of episodic migraines. Chronic migraines simply last longer or happen more often. Chronic migraine also involves headaches.
To receive this diagnosis, you must have:
As mentioned, migraines aren’t the same as headaches, and they can take different forms. The symptoms you experience from migraine to migraine can also vary. Migraines happen in up to four stages (but not every migraine involves all four):
With chronic migraine, your symptoms must meet the following criteria:
Migraine without aura (must last between four hours and 72 hours)
A headache phase that meets at least two of the following criteria:
A headache phase that involves at least one of the following:
Migraine with aura
One or more of the following types of aura symptoms:
At least three of the following criteria:
Migraines can be genetic, meaning you’re more likely to have migraines if you have a close biological relative, especially a parent or grandparent, with this condition.
Researchers also suspect several processes could contribute to migraines, including:
Several factors increase your risk of developing chronic migraine or contribute to making it worse. These include having:
Episodic migraines can sometimes “transform” into chronic migraine. That often happens because of processes that experts still don’t fully understand. There’s evidence that overuse of certain migraine treatments is a possible contributor to this transformation. The term “overuse” here doesn’t automatically refer to a substance use disorder, and it can happen even with medications that aren’t habit-forming.
Because of the risk of transformation, experts strongly recommend against frequent use of certain medications if you have episodic migraine. Medication overuse can also act as a trigger in some cases.
Foods, substances, smells, sounds or other environmental factors or circumstances can trigger the start of a migraine, typically within hours or days.
The most common triggers include:
Complications of migraines are possible but uncommon. They include:
A healthcare provider can diagnose migraines using a combination of approaches. A neurological exam is usually one of the first steps. Your provider will also ask questions about your health history, daily life, routine and activities. Questions usually relate to:
Your provider may recommend certain tests, especially diagnostic imaging scans, such as a computed tomography (CT) scan, to rule out life-threatening conditions like stroke. This is most likely when you have severe neurological symptoms, especially hemiplegia, as this is a key sign of a stroke. In non-emergency situations, you may have a magnetic resonance imaging (MRI) scan instead of or along with a CT scan.
Other tests are also possible, depending on your symptoms. Your healthcare provider is the best person to tell you more about the tests they recommend and why they think these tests are necessary
Chronic migraine treatments are similar to migraine treatments in general. Medications are the main form of treatment, and there are two main treatment approaches:
There are medical procedures that may be an option for chronic migraine. Mental healthcare options can also be a part of treatment.
Preventive medications are useful for chronic migraine because they make migraines less severe or happen less often. Preventive medications can include:
These medications shorten a migraine and/or make it less severe. Experts often recommend using these carefully because overuse can lead to or worsen chronic migraine.
OTC and NSAID medications that can treat migraines include:
*NOTE: Acetaminophen isn’t an NSAID. It’s available over the counter, and experts often include it along with NSAIDs because of its similarities.
Some over-the-counter migraine medications combine NSAIDs with caffeine. It’s a good idea to talk to your provider about whether or not to avoid caffeine-containing products, and to read labels to make sure you’re not taking these products unintentionally.
These are typically the first-line prescriptions for migraines. These drugs (including the brand names most often used) are:
Your healthcare provider may recommend against using these to treat chronic migraine. Using these too often can cause medication overuse headaches or contribute to transforming episodic migraines into chronic migraine.
This medication causes blood vessels in your brain to narrow and affects pain signal processing. The brand name form of ergotamine is Ergomar®. Brand name combinations of ergotamine and caffeine include Cafergot® and Migergot®.
These drugs combine an NSAID and a controlled medication, such as a barbiturate or an opioid painkiller. These can make chronic migraine worse, so they aren’t common in treating this condition.
There are a few medical procedures that may help with chronic migraine, including:
Psychotherapy (the formal term for mental health therapy) may help people with stress and anxiety, which both contribute to migraines. There are many forms of psychotherapy, so you have options to choose from when looking for a method that works for you.
Experts don’t fully understand how or why chronic migraine happens. Because of that, it’s impossible to prevent it with 100% certainty. Some people may be able to reduce their risk of developing chronic migraine, but others with a family history may develop it even if they take precautions.
If you have episodic migraine, the only thing you can do to reduce your risk of developing chronic migraine is to reduce the chance that your medications could contribute to the transformation from episodic migraines to chronic migraine. Your healthcare provider can guide you on using medications wisely and how to reduce the risk of transformation.
Migraines are very disruptive and make it difficult or nearly impossible to go about your activities as usual. They can disrupt work, household chores and activities, recreational and social plans, and more.
Chronic migraine means you have migraines at least eight times per month for at least three months. Because migraines are disruptive and this condition causes them to happen frequently, experts consider chronic migraine a very disabling condition, meaning it keeps you from doing certain things.
Migraines aren’t usually dangerous, but they greatly disrupt your life. They also increase your risk of life-threatening conditions like stroke and heart attack. Some migraine symptoms can also look like stroke symptoms. Because of that, chronic migraine needs expert monitoring and treatment.
Chronic migraine may not last as long for some people as for others. Some people may have it for months or years, while others may live with it for decades.
Family history, personal circumstances, triggers, treatment effectiveness and other factors can affect how long you have this condition. Your healthcare provider is the best person to tell you what you should expect in your case, and what you can do to reduce how long this condition affects your life.
Chronic migraine is a condition that can shift and change throughout your lifetime. Between 26% and 70% of chronic migraine cases will transform back into episodic migraine. However, some people will bounce between having episodic migraines and chronic migraine over time.
Migraines tend to become less frequent as you get older. This is especially true for women and people assigned female at birth, as migraines typically happen less often or completely stop after menopause.
If you have chronic migraine, there are many things you can do to help take care of yourself. These include:
Many foods or beverages can trigger migraines, and triggers can vary from person to person. A migraine journal can help you figure out and avoid your triggers.
Many common trigger foods or beverages involve similar processing methods. These include:
If you have chronic migraine, you should see a healthcare provider (typically a neurologist) regularly for ongoing care. Your provider can recommend an appointment schedule. You should also talk to your provider if you notice symptom changes, especially ones that affect your routine, lifestyle or activities.
You should go to the ER if you have symptoms that can also happen with dangerous or life-threatening conditions. Examples include:
Chronic migraine isn’t dangerous (except in rare cases), but it is serious. Migraines can be disruptive and make it difficult — or impossible — to go about your usual activities. Having chronic migraine means you have at least eight migraines per month for at least three months. Because this condition involves frequent migraines, which can be extremely disruptive, experts consider it a serious condition.
Yes, chronic migraine (and migraines overall) can go away. One way this can happen is with age. Chronic migraine can also transform into episodic migraine, which is often a goal of treating this condition. Episodic migraines are easier to manage and treat and less disruptive because they happen less often.
A note from Cleveland Clinic
A migraine isn’t just a bad headache. Having a migraine often means lying in a dark, quiet room because light and sound cause unbearable pain, nausea and other symptoms. The dark, quiet room doesn’t make symptoms stop. It only keeps them from being even worse. When you have migraines, the symptoms can be frustrating. But sometimes, what’s even more frustrating is trying to explain the experience to those who don’t understand or make assumptions about how it feels.
Fortunately, chronic migraine is often treatable. You can also make small changes to your daily life to reduce the frequency and severity of your migraines. If you combine treatment and manage your migraines, it’s possible to reduce how often you have them and shift your condition to a less severe form. That way, you can focus on your life and not just live from one migraine to the next.
Last reviewed by a Cleveland Clinic medical professional on 04/01/2023.
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