Chronic migraine is a neurological condition. It causes severe head pain, nausea, vomiting, and other visual and physical symptoms.

When diagnosing chronic migraine, doctors look at the frequency and symptoms of a person’s headaches. At present, there are no lab tests to diagnose the condition.

Once a person has a diagnosis, they can begin treatment. These include medications and trigger reduction.

Read more to learn about what chronic migraine is, treatment options, and more.

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Chronic migraine (CM) causes a person to have at least 15 headaches per month for 3 or more months. To be diagnosed with CM, eight of those headache episodes should involve migraine symptoms.

People with migraine symptoms but fewer headaches per month may have episodic migraine (EM). An EM episode can last several hours. They typically occur weeks or months apart.

Symptoms of CM include head pain that is:

  • moderate to severe
  • pounding, throbbing, or pulsating
  • on one side of the head (unilateral) or both (bilateral)
  • focused on the front or back of the head, or both
  • around the eyes or behind the cheeks
  • aggravated by physical activity
  • severe enough for the person to miss school or work

Other CM symptoms include nausea, vomiting, and sensory symptoms such as muscle weakness and visual impairment. These sensory symptoms are called migraine with aura.

CM symptoms are similar to EM symptoms. The main difference is their frequency and duration.

A person experiencing CM symptoms should contact a doctor or other healthcare professional. A doctor may refer the individual to a neurologist or headache specialist.

When determining if a person has CM, a doctor will look at headache symptoms as well as headache frequency and duration.

According to the International Headache Society (IHS), the diagnostic criteria for CM are:

  • having a headache for 15 or more days per month for more than 3 months
  • having at least five headaches while experiencing certain symptoms of migraine with and without aura
  • having headaches on 8 or more days for more than 3 months while experiencing symptoms of migraine with and without aura

A headache specialist usually has the person keep a headache diary. They should record their headache symptoms and frequency. This helps a doctor rule out potential causes.

In a 2019 study, researchers proposed the IHS revise the diagnostic criteria. They suggested it include people who have eight migraines per month.

Similarly, researchers in a 2021 study said the current 15-day threshold does not adequately reflect the burden of illness or treatment needs of people with CM.

There are two types of treatment for CM: preventive medication and acute medication.

Acute medications are meant for the start of a migraine attack. Frequent use of these can lead to a medication overuse headache, so it is important to closely follow a doctor’s instructions.

Preventive medications are a long-term treatment option. They may reduce migraine severity and frequency.

Evidence-based preventive medications include the prophylactic treatments topiramate (Topamax) and onabotulinumtoxinA (Botox). Doctors also regularly prescribe monoclonal antibodies, such as galcanezumab (Emgality), erenumab (Aimovig), and fremanezumab (Ajovy), as preventive treatments.

Many people add complementary therapies to their individual treatment plans. They may also identify and avoid triggers.

Complementary therapies

Typically, complementary therapies are preventive techniques that do not require medication. Some examples include biofeedback and cognitive behavioral therapy.

The National Center for Complementary and Integrative Health outlines several relaxation techniques for migraine management and prevention. Examples include progressive relaxation, breathing exercises, and self-hypnosis.

Trigger management

CM triggers can vary from person to person, but some include lack of nutrients, sleep deprivation, and dehydration.

Mental and physical health conditions may also trigger attacks.

Conditions like depression, anxiety, and fibromyalgia can trigger or worsen migraine attacks. Treating these conditions is an important part of managing CM.

Mental health

The American Migraine Foundation estimates about half of people with migraine also have anxiety, while around a quarter have depression.

People with mental health conditions should seek treatment. Depression and anxiety can worsen migraine symptoms, as well as lead to additional health problems and affect the quality of life.

Some headaches have symptoms similar to migraine headaches, including:

  • Cervicogenic headaches: In these headaches, the pain stems from the neck spine.
  • Cluster headaches: These severe headaches occur several times a day, sometimes for multiple days, weeks, or months (known as a “cluster period”).
  • Ice pick headaches: These are brief, intense stabs of pain.

People who experience these symptoms can talk with a doctor for a proper diagnosis and treatment plan.

Anyone experiencing migraine headache symptoms may consider contacting a doctor.

Additionally, a person with an existing CM diagnosis should contact a doctor if they experience more frequent or severe migraine episodes.

There are also times to immediately seek emergency medical attention. For example, when a person experiences symptoms that are new or unusual to them, including:

  • extreme nausea and vomiting
  • double vision or vision loss
  • impaired speech
  • weakness or dizziness
  • body numbing or tingling
  • fever
  • confusion
  • trouble breathing
  • seizures

These symptoms — or a sudden and unusual migraine attack — can indicate a medical emergency.

A person should visit the emergency room if they have a migraine episode:

  • after a head injury
  • while pregnant
  • along with another medical condition such as kidney, liver, or heart disease
  • along with a condition that affects their immune system, such as HIV

Chronic migraine is not a typical series of headaches. It is a neurological condition with specific diagnostic criteria and symptoms ranging from severe head pain to muscle weakness.

Treatment options include medications, breathing exercises, and progressive relaxation. Additionally, people with CM may benefit from identifying and avoiding migraine triggers.

With the right treatment and trigger monitoring, it is possible to manage CM.