Chronic Migraine: Overview

By Dr. Pallavi Sharma

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Chronic Migraine is a serious condition that affects millions of people around the world.

While there is no cure, there are many ways to manage your symptoms and reduce your risk of migraine attacks.

One in ten of the world’s population is suffering from migraines, and the majority of sufferers are females.

If you scroll down, this article will explain migraine and their variants.

Chronic Migraine: What is it?

Migraine is caused by an imbalance in the brain’s chemical levels. There are four main types of migraines. They are as follows,

Classic Migraine

Since there is an aura phase and the migraine follows all four phases of a migraine, this is called Classic Migraine.

This type of migraine occurs when you have a constant, severe headache for at least 4 hours that begins on one side of your head and moves to another side of your head or face.

The pain can be so bad it prevents you from doing even the simplest tasks like walking or talking. The pain may also be accompanied by nausea, sensitivity to light and sound, and extreme fatigue or sleepiness.

Common Migraine

This type of migraine has fewer symptoms than classic migraines and often occurs without warning or aura symptoms.

It can cause intense throbbing headaches that usually last less than 12 hours per month or so but may continue for days at a time if untreated.

Common migraines also tend not to cause nausea or sensitivity to light and sound as frequently as classic migraines do.

Complex migraine

This type of migraine doesn’t have all four stages of migraine. It can be associated with one-sided body weakness (hemiplegic migraine) and vision loss (Ophthalmegia migraine).

Chronic migraine

The fourth type of migraine is chronic migraine.

The term “chronic migraine” is used to describe a condition in which a person has 15 or more headache days per month.

Chronic migraine can result in other symptoms such as nausea, vomiting, light and sound sensitivity, and neck pain.

Chronic migraine is often difficult to diagnose because the symptoms are similar to other conditions, such as chronic tension-type headaches.

If a person experiences fewer than 15 attacks per month, it is called episodic migraine.

Episodic migraines can become chronic migraines. This percentage is around 3 % each year.

Risk Factors for Chronic Migraine

There are some risk factors for chronic migraine. These are as below.

  • Medication overuse
  • Emotional Liability-Depression, anxiety, or susceptibility to emotional trauma
  • A family history of chronic migraines
  • Sleep apnea
  • Obesity
  • Trauma to the neck or head
  • Pain disorders
  • Frequent nausea
  • Asthma 
  • Females are more likely to suffer from chronic migraines. The frequent age of chronic migraines is the age of 30 years old.

Causes of Chronic Migraine

The cause of chronic migraine is not well understood. It’s often linked to the nerves in the brain that control sensations.

Some people have chronic migraines due to genetic disorders.

The most accepted cause of chronic migraine is medication overuse.

Migraine sufferers use over-the-counter medications such as acetaminophen, ibuprofen, naproxen, and tramadol as preventive medications.

This is due to the fact that they identify false symptoms as prodromal stages and tend to take the medications.

Thus, overusing medications can cause rebound headaches that will lead to chronic episodes of migraine.

Uncontrolled stress can also trigger chronic migraine attacks.

Chronic migraine symptoms

The symptoms of chronic migraine are different from those of other types of migraine. Chronic migraine affects up to 1% of the general population.

Symptoms of chronic migraine include:

  • Headache that has been recurring for more than 15 days per month over 3 months (with at least 8 headaches per month)
  • Headache lasting more than 4 hours
  • Disabling pain
  • Sensitivity to light and sound
  • Nausea and vomiting
  • Dizziness
  • Depression and anxiety
  • Increase frequency of medicine intake per month
  • Total doses of medications are increasing over time.

Diagnosis of Chronic Migraine

History, physical examination, and neurological examination are important to diagnose chronic migraine.

The physician will ask the following questions to diagnose chronic migraine in you.

  1. When did you first suspect you had a migraine?
  2. What triggers migraines in you?
  3. What are the symptoms you feel before , during, and following a migraine attack?
  4. How frequently do you feel migraines per month?
  5. Where did you feel the headache?
  6. Are you taking other medicines besides migraine medication?
  7. Do you have problems with migraines?
  8. What are the drug doses you are currently on?
  9. Are you on other therapies besides taking drugs?

The doctor will categorize the type of your migraine based on your medical history and examinations, and if there is any uncertainty, a CT or MRI will be performed.

Treatment of Chronic Migraine

The pain and symptoms associated with chronic migraines are much more intense than episodic migraines and can significantly affect one’s life in many ways:

  • reduced quality of life
  • reduced productivity at work or school
  • difficulty maintaining relationships because of frequent absences

Thus, treating chronic migraine is a challenge. The following are the steps to treating chronic migraines.

Lifestyle modifications

The first step is to change your behavior and lifestyle.

Stress

Stress is the main trigger for chronic migraines. If you cannot control your chronic stress, it may lead to chronic suffering. Relaxation techniques, yoga, meditation, and being mindful help to relieve migraine frequency.

Sleep Hygiene

Maintaining a sleep schedule and reducing screen time may be helpful.

Regular Exercises

Losing body weight and non-strengthens exercises might be helpful.

Get Expert Help!

If you are having mood disorders, depression, anxiety, or emotional liability, seek psychiatrist help.

Eating Habits

Eat regularly and avoid triggers. Eat fresh veggies and fruits often. Do not skip meals.

Medicines for Chronic Migraine

There are many different treatments available to help chronic migraine sufferers, which include prescription drugs, over-the-counter medications, and lifestyle changes such as dieting and exercise.

Over-the-counter Medicines

As pain relievers, the following drugs may be beneficial.

  • Acetaminophen-Tylenol
  • NSAIDs: naproxen, ibuprofen.
  • Excedrin is a combination of a pain reliever and caffeine.

Triptans

These medications are used to relieve severe pain in migraine attacks.

They work by blocking signals sent from the brain to the nerves that cause the pain.

Triptans are often taken by mouth but can also be given as injections or sprayed into the nose or eyes.

Some of the drugs called triptans are sumatriptan and rizatriptan.

Anti-nausea Drugs

Chlorpromazine and metoclopramide can be bought over the counter and are effective for vomiting.

Opioids

There is a high risk of addiction. So, this medication is used as a last resort to pain killer.

Prevention of Chronic Migraine

Migraine headaches can be prevented with preventive medication.

Preventive medicine is a type of medicine for migraine headaches that is taken before the headache occurs.

It’s also called prophylactic treatment or preventative treatment. Preventive medications are not meant to cure migraines but rather to help prevent them from happening again in the future.

Preventive medications include:

  • Anticonvulsants (medicines used to treat seizures)
  • Beta-blockers (medicines used to reduce blood pressure)
  • Calcium channel blockers (this is used as a vasoconstrictor)
  • Ergotamine (medicines that increase blood flow to the head)
  • Calcitonin gene-related peptide (CGRP): Fremanezumab, galcanezumab.

CGRP is a monoclonal antibody and reduces inflammation in migraine.

  • Botox Injection (botulinumtoxin A) every 10 weeks

Preventive medication is one way to help reduce the frequency of migraines in the future. While there are many different types of preventive medications, most are designed to reduce symptoms and prevent attacks from occurring.

Complications of Chronic Migraine

There are many complications from chronic migraine as there is a change in frequency of attacks, increased drug side effects etc. Some of the most common include:

  •  Rebounding headaches
  •  Memory loss
  •  Severe depression
  •  Insomnia
  •  Migrainous vertigo
  •  Hemiplegic Migraine.
  •  Medication overuse-rebounding headache
  •  Drug intolerance

When to Seek Professional Help!

If your doctor prescribes a prescription migraine medicine, take it as directed by your doctor.

Some medications may not be effective if you stop taking them too soon after starting them; others work best if you take them daily over the long term.

If you don’t respond well to one migraine medication, it’s important to talk with your doctor about other options like Botox injections or surgery to block nerve signals that lead to pain signals in the brain.

Migraine is a complex disorder, and there are many different ways it can manifest.

Because of this, it’s important to have a conversation with your doctor if you have any of the following symptoms:

  • Headaches that last more than 72 hours
  • Hemiplegic symptoms
  • Fever and neck stiffness
  • Acute onset of headache without migraine stage as a thunder clap
  • Change in frequency of symptoms
  • Slurring of speech
  • confusion
  • vertigo
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TeleHealthDoc articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Dr. Pallavi Sharma

Dr. Pallavi Sharma is one of Melbourne’s best, well respected cosmetic doctors and aims to provide longstanding anti-aging benefits for her clients. With over 11 years experience in Performing cosmetic procedures, Dr. Sharma has lectured medical professionals regarding cosmetic treatments and is heavily involved in providing up to date cosmetic treatments to her clients and friends.
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