What Are Chronic Migraines? Neurologists Describe the Causes and Treatments

Pulsing pain? Light sensitivity? Here’s what you can do to manage these frequent headaches.

The world can suddenly become unbearably loud and bright, while your head throbs with relentless pain. If you’ve experienced migraines, you’re well-acquainted with the overwhelming urge to seek refuge in a dark, cool room. Now, imagine enduring this ordeal several times every month. Chronic migraine sufferers grapple with a condition that not only disrupts their lives but also often accompanies a host of non-migraine headaches. In this comprehensive exploration, we’ll delve into the intricacies of chronic migraines, their symptoms, underlying causes, diagnostic procedures, and treatment options, shedding light on a condition that affects millions worldwide.

Understanding Chronic Migraines

Chronic migraines are distinct from typical migraines not only due to their frequency but also because most chronic migraine sufferers experience non-migraine headaches on the remaining days of the month. Dr. Robert Cowan, a professor of neurology and chief of the division of headache medicine at Stanford University, highlights that patients frequently misjudge the number of migraines they endure. They might say they have two migraines a week, but upon further reflection, they acknowledge experiencing daily regular headaches alongside those migraines. The definition of chronic migraine, as per the International Classification of Headache Disorders, is a condition in which a patient endures headaches on more than 15 days per month, with at least eight of those days featuring migrainous characteristics.

Symptoms of Chronic Migraines

For migraine sufferers, migraines typically manifest as predominantly one-sided headaches accompanied by nausea, sensitivity to light, sound, and sometimes exacerbated by physical activity. According to the American Migraine Foundation, typical migraine symptoms include:

• Moderate to severe pain, often on one side of the head (though it can occur on both sides)
• Throbbing or pulsing pain
• Sensitivity to light
• Sensitivity to sound
• Sensitivity to smell
• Sensitivity to touch
• Nausea and vomiting
• Dizziness
• Pain worsened by exercise

Chronic migraines, however, encompass “headache” days in addition to these migrainous episodes. General headaches, as described by the Cleveland Clinic, feature consistent, mild-to-moderate pain without throbbing, often occurring on both sides of the head, and responding positively to over-the-counter treatments.

Unpacking the Causes of Chronic Migraines

Genetics play a substantial role in determining an individual’s susceptibility to migraines. Dr. Cowan humorously attributes migraines’ main cause to “poor parental selection.” If a family member has a history of migraines, the likelihood of experiencing them increases significantly. Migraines predominantly affect women and typically commence during adolescence, although onset can occur at any age. They tend to peak in severity during one’s 30s and gradually decrease in frequency, according to the Mayo Clinic. While the exact mechanisms that trigger migraines remain somewhat elusive, they may be linked to changes in the brainstem or imbalances in brain chemicals.

Several risk factors heighten the likelihood of chronic migraines, including obesity, medication overuse, asthma, and sleep disturbances. Proper assessment of coexisting health conditions is essential, as managing these conditions can reduce migraine frequency.

Identifying Migraine Triggers

Migraine triggers can encompass various factors, with the most common being alterations in sleep patterns, particularly poor sleep quality. Changes in dietary routines or excessive physical activity relative to one’s usual level can also induce migraines. Hormonal fluctuations, such as those during menstruation, alcohol or caffeine consumption, exposure to bright lights, strong odors, loud noises, and specific foods can serve as triggers. However, it’s crucial to recognize that triggers often interact with one another, making it challenging to isolate a single cause. For instance, a person may blame a migraine on consuming blueberries, but in reality, it could result from a culmination of factors, including inadequate sleep and high stress.

Diagnosing Chronic Migraines

Diagnosing chronic migraines typically relies on clinical evaluation rather than imaging. As Dr. Cowan emphasizes, a comprehensive medical history accounts for 95% of the diagnosis in headache patients. Maintaining a headache journal, recording the details of each episode, is invaluable for a thorough assessment. Physicians rely on the number of headache days per month, rather than disability level, to diagnose chronic migraines.

A physical examination may involve assessing neck mobility and examining specific nerves around the head and temples to guide treatment decisions. Frequent headaches necessitate the exclusion of alternative causes through medical evaluation, as highlighted by the American Migraine Foundation.

Effective Management Strategies

Chronic migraines necessitate a multifaceted approach to treatment. Two primary categories of medications are employed: preventive medications to reduce the monthly migraine frequency and acute medications for immediate relief when a migraine commences. Often, patients require both.

Acute medications, including over-the-counter options like ibuprofen or aspirin, along with prescription triptans such as sumatriptan and rizatriptan, are meant to be administered at the first sign of a migraine. Preventive medications encompass oral options like beta-blockers, antidepressants, and antiepileptic drugs. Injectable therapies like Botox or calcitonin gene-related peptide (CGRP) inhibitors may also be recommended.

A notable advancement in migraine treatment is the emergence of oral CGRP blockers, such as Nurtec (rimegepant) and Ubrelvy (ubrogepant), approved for both acute and preventive use. These medications target the inflammatory pathway, effectively curbing the inflammation leading to migraines.

However, understanding and mitigating migraine triggers are vital. Dr. Mason Dyess, a neurology and headache medicine physician at Ochsner Medical Center in New Orleans, emphasizes that effective migraine management may reduce the impact of triggers. Until an effective regimen is established, individuals are advised to avoid known triggers.

When to Seek Professional Help

If you are grappling with migraines, it is crucial to consult a healthcare provider, particularly if their frequency intensifies. Dr. Cowan raises concern about patients who transition from experiencing two headache days per month to six or eight. Although they may still be classified as episodic migraine sufferers, their condition poses a significant threat. Without intervention, these individuals are at risk of becoming disabled by their migraines.

In conclusion, chronic migraines present a complex and often debilitating condition that affects numerous individuals worldwide. Understanding the symptoms, causes, triggers, diagnosis, and treatment options is essential for those impacted by this condition. Seeking medical guidance is pivotal to tailor a comprehensive management plan that includes preventive and acute medications, lifestyle adjustments, and the identification and avoidance of migraine triggers. Chronic migraine management is not merely about reducing pain; it’s about reclaiming control and improving one’s overall quality of life.