Migraine is a neurological condition that can be either episodic or chronic. Episodic migraine occurs less frequently, while chronic migraine occurs at least 15 days out of every month.

For some, episodic migraine evolves into chronic migraine. However, this only happens in a minority of people.

Even though episodic migraine is less frequent, both episodic and chronic migraine can have a significant impact on daily life. They may affect a person’s ability to work, their social life, and their relationships.

This article explores the differences between episodic and chronic migraine, their causes, and treatments.

Photo collage of a person with hands on their face, and a woman lying down in bed, due to migraine.Share on Pinterest
Design by MNT; Photography by Catherine Falls Commercial/Getty Images & Guido Mieth/Getty Images

“Episodic” and “chronic” are ways of describing the pattern of symptoms in people with migraine.

Episodic migraine causes symptoms on fewer than 15 days per month with symptom-free intervals in between. Chronic migraine causes symptoms on 15 or more days per month for at least 3 months, with at least eight of those episodes meeting the criteria for migraine headache.

Chronic migraine is a more persistent and severe form of the condition. However, all migraine types can be challenging to live with.

Yes, it is possible to experience both episodic and chronic migraine, although not at the same time.

Some individuals may begin with episodic migraine and, over time, experience a transition to chronic migraine. This is known as migraine transformation or progression.

Scientists are not entirely sure why this happens. Factors that may increase the risk of migraine progression include:

  • a high baseline number of migraine episodes
  • medication overuse
  • stressful life events
  • obesity
  • female sex
  • lower socioeconomic status

People with chronic migraine also often have mental health conditions such as anxiety or depression.

Migraine may exacerbate some of these risk factors, but the reverse could also be true. For example, episodic migraine could worsen stress or anxiety, but stress and anxiety could also worsen migraine. This is known as a bidirectional relationship.

Researchers are still learning about the potential links between these risk factors and migraine development.

No, most people with episodic migraine never develop chronic migraine. A 2021 review of previous research notes that the progression rate from episodic to chronic is around 3% per year.

The symptoms of episodic and chronic migraine are generally similar. The main difference between the two is how often the symptoms occur and for how long.

The symptoms of both episodic and chronic migraine can include:

  • moderate-to-severe head pain, often on one side of the head
  • nausea
  • vomiting
  • sensitivity to light or sound

Not everyone experiences all of these symptoms. Some people may have nausea but not vomiting, while others can experience silent migraine, which means they get some of the symptoms but no pain.

Some people also experience auras shortly before a migraine episode. These are temporary sensory disturbances that can include vision changes, hearing sounds, or sensations on the skin.

Migraine symptoms may last from a few hours to up to several days. In chronic migraine, individuals may experience headaches more frequently and for extended periods.

Additionally, chronic migraine may link to an increased risk of medication overuse headache, which can feel similar to migraine. These headaches occur when a person uses too many pain medications to manage their symptoms.

The exact cause of migraine is unclear, but researchers do know it involves a complex series of changes that take place in the brain and nervous system.

Some research highlights the trigeminal system as the source of the pain. This system includes the trigeminal nerve, which starts at the ear and then splits into three branches that reach behind the eyes, nose, and down toward the jaw.

Sensitization of these nerves due to chemical reactions in the body could be what causes migraine pain. However, the reasons why these reactions take place are complex and not fully understood.

People are more likely to have migraine if they:

Many people with migraine also notice that certain things can trigger an attack, such as:

  • stress
  • flashing or bright lights
  • hormonal changes
  • noisy environments
  • strong smells
  • certain foods
  • weather changes
  • sleeping too much or too little
  • caffeine, or caffeine withdrawal
  • tobacco

People who have periods can also find that migraine becomes more frequent in the time leading up to menstruation or during menopause.

If a person has episodic or chronic migraine, their doctor may recommend the following to treat an attack:

  • Pain medications: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can alleviate mild to moderate episodic migraine pain.
  • Triptans: These medications specifically treat migraine, but a person should not take them more than 10 days per month.
  • Anti-nausea medications: Metoclopramide or ondansetron can ease nausea or help prevent vomiting.

For pain medications to work, doctors recommend taking a single dose as soon as a person feels symptoms coming on. This gives the medications the best chance to stop the migraine episode from progressing.

To help prevent migraine episodes from occurring as frequently, a doctor may suggest:

  • Lifestyle changes: Identifying and avoiding any migraine triggers may help reduce how often episodes occur. People can start by keeping a migraine diary and taking note of what happened before it began. This could include what a person ate, how they felt, their sleep, or, for females, where they are in the menstrual cycle.
  • Preventive medications: Beta-blockers, antiepileptic drugs, and certain antidepressants may reduce the frequency and intensity of attacks.
  • Botox: Injections of onabotulinumtoxinA (Botox) are an approved treatment for chronic migraine. This involves getting injections every 12 weeks to reduce headache frequency and severity.
  • Neuromodulation devices: Treatments such as transcranial magnetic stimulation or noninvasive vagus nerve stimulation may help with chronic migraine.
  • Biofeedback: This complementary therapy teaches a person how to become aware of, and eventually control, unconscious bodily functions. For example, they may learn how to relax or reduce muscle tension.
  • Mental health treatment: Migraine is a physical condition, but it does appear to have a connection with mental health conditions. Cognitive behavioral therapy can help address emotional and psychological factors that may cause or worsen migraine, such as anxiety. It may also help a person cope with the impact migraine has on their life.

Consulting a doctor with experience treating migraine can help identify the most effective therapies to manage the condition and improve quality of life.

Migraine is a complex neurological disorder that can present in two main forms: episodic and chronic. Episodic migraine involves distinct headache episodes with symptom-free intervals, while chronic migraine is more frequent, occurring at least 15 days per month for 3 months.

While both types share standard treatment options, chronic migraine may require a more comprehensive approach due to its frequency and the severity of its symptoms.

Episodic migraine can transform into chronic migraine, but this is uncommon. People who are concerned about their symptoms should speak with a doctor who has experience treating migraine, wherever possible.