Chronic Migraines


Chronic Migraines are described as headaches occurring 15 or more days a month. This is also referred to as transformed migraines, which are chronic daily or near-daily. Chronic migraines, along with cluster headaches, are a subset of chronic daily headache (CDH). Chronic migraines last on average longer than four hours. Migraines affect approximately 38 million Americans, or 14% of the population, while 4% suffers from chronic migraines. Chronic migraines sufferers often suffer from depression due to the fact that they have failed personal relationships and a general sense of hopelessness due to the fact that they are unable to find a treatment option that helps.


Migraine pain attacks which appear at least 15 times in a month are considered chronic migraines. The attacks will generally include two or more of the following:

  • Pulsating, throbbing pain
  • Pain level is moderate to severe
  • Pain is made worse by activities and movement
  • Pain located unilaterally
  • Sensitivity to sound and/or light
  • Nausea and/or vomiting


Diagnostic criteria:

A. Headache (tension-type and/or migraine) on ≥15 days per month for at least 3 months
B. Occurring in a patient who has had at least five attacks fulfilling criteria for migraine without aura
C. On ≥8 days per month for at least 3 months, headache has fulfilled criteria for pain and associated symptoms of migraine without aura
D. Has at least two of the following:

  • Unilateral location
  • Pulsating quality
  • Moderate or severe pain intensity
  • Aggravation by or causing avoidance of routine physical activity

E. Has at least one of the following:

  • Nausea and/or vomiting
  • Photophobia and phonophobia

F. No medication overuse and not attributed to another causative disorder


Treating chronic migraines can be very difficult. In many cases, tolerance to medications develops resulting in attacks occurring more frequently. Changes in sleep patterns, especially those of shift workers, can trigger an episode, especially if they result in loss of sleep. There may also be unidentified ‘triggers’, such as food sensitivities or stress, that may be responsible for what seem (to the patient) to be causing constant migraines.

Many of the therapies prescribed for chronic migraines include both prescription and over the counter painkillers and as well as migraine-specific drugs such as triptans, known as abortive medications.
A combination of lifestyle changes and understanding the migraine triggers is critical when treating chronic migraines.

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