Healthcare professionals consider migraine chronic when headaches occur on 15 or more days per month for more than 3 months. On at least eight of those days, headaches must have common features of migraine, such as severe pain or associated visual-auditory symptoms.

Migraine is one of the most common headache disorders, affecting up to 1 in 5 people in their lifetime. Among people with migraine, approximately 1 in 12 will develop chronic migraine.

In this article, we answer some of the common questions about how to treat chronic migraine, including how to stop headaches before they start.

Alongside lifestyle and trigger management, there are two main pillars to the medical treatment of chronic migraine: acute headache treatment and preventive treatment.

Acute migraine treatment

The goal of acute migraine treatment is to provide fast or immediate relief from headache pain and other migraine symptoms.

Many migraine-specific and nonspecific pain medications can treat migraine headaches. Some of the most common include:

  • triptans, such as sumatriptan
  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil), or naproxen (Aleve)
  • acetaminophen (Tylenol)
  • calcitonin gene-related peptide (CGRP) receptor antagonists, known as gepants (Nurtec, Ubrelvy)
  • serotonin 5-HT1F receptor agonists, known as ditans (Reyvow)

People take these kinds of medications when a migraine headache occurs. They may be available by prescription or over the counter. Most are available in forms that a person can take by mouth, but there are alternative delivery options if nausea or vomiting is a big concern.

In some cases, people can also use devices to deliver electrical stimulation that helps regulate pain signals.

These devices are known as neuromodulatory devices. They are suitable for people who do not respond well to acute migraine medications or cannot take oral medicines due to nausea or vomiting.

Neuromodulatory devices can also be a good option for additional as-needed pain relief. Insurance companies may limit the number of acute medication doses in a prescription, so people who need more relief may benefit from using a device.

Preventive migraine treatment

Preventive treatment is a key part of care for people with chronic migraine.

The goal of preventive care is to reduce the frequency, severity, and length of migraine attacks and to lessen the reliance on acute migraine treatments.

Both oral and injectable options are available for migraine prevention.

These medications all work in different ways to reduce factors that lead to overstimulation of the nervous system and increase the likelihood of a migraine episode occurring.

Oral medications include:

  • beta-blockers, such as propranolol (Inderal), metoprolol (Toprol), and atenolol (Tenormin)
  • angiotensin blockers, such as candesartan (Atacand)
  • tricyclic antidepressants, such as amitriptyline (Elavil) and nortriptyline (Pamelor)
  • anticonvulsants, such as topiramate (Topamax) and sodium valproate (Depakene)
  • atogepant (Qulipta)

In most cases, people start with a low dosage of these medications to see how well they work. If necessary, doctors can slowly increase the dosage to get to an optimal level.

Injectable medications can also help with migraine prevention. The options include:

  • onabotulinumtoxinA (Botox)
  • anti-CGRP monoclonal antibodies, such as erenumab (Aimovig), eptinezumab (Vyepti), fremanezumab (Ajovy), and galcanezumab (Emgality)

Every person with migraine responds differently to treatment, and there is no one optimal treatment for everyone.

A doctor will help decide the right treatment plan based on a person’s individual needs, including their migraine symptoms and treatment goals, response to treatment, potential side effects, and cost considerations.

In most cases, migraine does not completely resolve. People with chronic migraine may, however, experience periods of reduced headache burden, returning to a state of episodic migraine.

Longitudinal studies have found that up to three-quarters of people with chronic migraine experience at least some remission at least once per year.

Although the symptoms may improve with treatment, there is no cure for chronic migraine.

The goal of chronic migraine treatment is to control the symptoms and reduce the impact of the condition on daily living.

In the search for the right treatment plan, experts recommend that people make the decision to stop treatment or reduce medication in partnership with a healthcare professional. Stopping treatment too soon may lead to worsening symptoms that may make it more difficult to re-achieve migraine control in the future.

A headache specialist can help establish the right treatment plan to prevent and manage the symptoms of chronic migraine.

However, it is important for people to be proactive and advocate for themselves during the migraine treatment process. Research suggests that less than 1 in 13 people with chronic migraine get an appropriate referral for migraine care, receive an accurate diagnosis, and ultimately receive effective treatment for their condition.

However, once a treatment plan for migraine is in place, it is important to stay the course and avoid overusing pain medications.

Medication overuse can actually worsen migraine symptoms. Some studies estimate that up to 70% of people with chronic headache experience headaches due to medication overuse.

If migraine attacks persist despite preventive and acute treatment, a headache specialist can help adjust a person’s medications to find a treatment approach that provides better relief.

A person’s brain chemistry and structure can increase their likelihood of experiencing migraine attacks.

These factors lower a theoretical “threshold,” making it more likely that symptoms will occur.

Certain factors can then push a person over that threshold, triggering a migraine attack.

In people with chronic migraine, certain risk factors may push them over the threshold, causing headaches to occur more frequently. Some known risk factors for migraine and chronic migraine include:

  • overuse of acute migraine medications
  • higher levels of female sex hormones
  • depression, anxiety, or stress
  • other pain disorders, such as fibromyalgia
  • conditions that create metabolic strain, such as obesity or sleep apnea

Keeping a record of the factors that trigger migraine attacks and then avoiding these factors when possible can be a helpful part of migraine care and prevention.

There is no cure for chronic migraine, but medical treatment and lifestyle changes might reduce the impact of the symptoms.

Doctors often recommend a combination of acute and preventive treatment, which may consist of oral or injectable medications.

Anyone who is experiencing frequent headaches, especially those that are severe or limit the ability to function, should consult a headache specialist. This specialist can work with the individual to create an effective treatment plan for them.