Some people may experience frequent migraine episodes, or “chronic” migraine, which can severely affect their quality of life. This may occur due to genetic factors or underlying physical or mental health conditions.

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A person who experiences chronic migraine may benefit from preventive medications and therapies to reduce the frequency of migraine episodes. They may also require medications to treat individual migraine episodes.

This article outlines the causes of chronic migraine and offers information on triggers, prevention, and treatment. We also offer advice on when to contact a doctor.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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According to a 2021 review, chronic migraine is when a person experiences headaches at least 15 days out of each month for at least 3 months, with migraine symptoms occurring on at least 8 of these days.

Migraine symptoms may include the following:

Some people experience an aura shortly before developing a migraine headache. An aura is a sensory phenomenon that may include one or more of the following symptoms:

Most cases of migraine have a genetic cause — a person is at increased risk of experiencing migraine if they have a close relative with the condition.

However, certain underlying conditions can cause migraine symptoms. Examples include:

  • an increase in cerebral spinal fluid (CSF) pressure due to a brain lesion
  • a decrease in CSF volume due to brain injury
  • acute or chronic meningitis
  • hypoxia, in which there is too little oxygen in the blood
  • hypercapnia, in which there is too much carbon dioxide in the blood
  • systemic inflammatory conditions, such as temporal arteritis
  • substance misuse or withdrawal
  • mental health conditions, such as depression or anxiety

In many cases, migraine occurs as a result of hormone fluctuations.

According to the United Kingdom’s National Migraine Centre (NMC), 50–60% of females experience menstrual migraine, which is a migraine that occurs shortly before or during a period.

Menstruation-related headaches are common in the perimenopausal period due to changes in estrogen levels.

A migraine trigger is an internal or external mechanism that can cause a migraine episode in a person who is already prone to experiencing them.

Some factors, such as altitude sickness, can cause migraine-like headaches in people who do not already experience migraine. Despite producing similar symptoms, these factors do not count as migraine triggers.

Migraine triggers can vary depending on the individual. A 2021 review of migraine triggers notes that stress is the most common trigger, accounting for 79.7% of migraine episodes.

According to the American Migraine Foundation (AMF), other common migraine triggers include:

  • irregular sleep patterns
  • hormone fluctuations
  • changes in the weather
  • exposure to natural or artificial light
  • exposure to certain odors
  • caffeine and alcohol consumption
  • consumption of certain foods, such as:
  • overuse of migraine medications

People may find that their migraine triggers overlap or are inconsistent.

Read more about migraine triggers here.

The treatment of chronic migraine involves medications and non-pharmaceutical therapies to help reduce the frequency of migraine episodes, alongside medications to alleviate migraine symptoms.

Preventive medications

The first-line preventive medication for chronic migraine is a class of drugs called beta-blockers. These drugs reduce blood pressure and the secretion of the hormone melatonin.

Examples of beta-blockers include:

In addition to beta-blockers, a doctor may prescribe tricyclic antidepressants (nortriptyline, amitriptyline) or anti-epilepsy drugs (topiramate, divalproex sodium) as first-line preventive medications. A doctor may also prescribe these drugs if beta-blockers do not successfully prevent migraine episodes.

In 2019, the Food and Drug Administration (FDA) approved a class of drugs called calcitonin gene-related peptide (CGRP) monoclonal antibodies to prevent migraine episodes. These medications limit the ability of nerves in the brain to pass on pain signals, reducing the chance of a migraine attack.

There is also evidence to suggest that the following therapies may help prevent frequent migraine episodes:

Pain relief

When treating a migraine headache, it is important to identify it and begin treatment as soon as symptoms appear. This is because it is much harder to reduce the pain once a headache intensifies.

With any type of migraine, the first stage of treatment involves taking an over-the-counter pain reliever. A nonsteroidal anti-inflammatory drug (NSAID) will likely be more effective than acetaminophen.

If NSAIDs are ineffective, a doctor may suggest taking a specific class of pain reliever called a triptan. These medications constrict the cranial arteries, which ordinarily dilate during a migraine attack.

To receive a diagnosis of chronic migraine, a person must experience headaches on at least 15 days per month, including 8 days with migraine symptoms. However, a person who has two or more migraine episodes per month should speak with a doctor to discuss preventive therapy.

A person already taking preventive medication for migraine should speak with a medical professional if they do not notice any improvement in their symptoms after 2–3 months of taking:

  • beta-blockers
  • tricyclic antidepressants
  • anti-epilepsy medications

Alternatively, they should speak with a doctor after 3–6 months of taking CGRP monoclonal antibodies.

Medical professionals will reassess the medication types and dosages and may change the person’s treatment plan.

Chronic migraine is the medical term for headaches that occur on at least 15 days of the month for 3 consecutive months, with migraine symptoms accompanying headaches on at least 8 days.

Most people who experience migraine have a genetic predisposition to the condition, though certain underlying factors can increase the risk of migraine. In addition, triggers can increase the frequency and severity of migraine episodes, depending on the individual.

Migraine can cause severe pain and affect a person’s quality of life. The treatment for chronic migraine includes short-term symptom management and long-term preventive measures.