Chronic Migraine: Causes, Symptoms and Treatment

Medically Reviewed by Poonam Sachdev on August 04, 2024
Written by Stephanie Booth, Kathryn Whitbourne
10 min read

A migraine is a very common type of headache. It causes a severe throbbing pain, often on one side of your head, along with nausea, vomiting, and/or sensitivity to light and sound. This means you find bright lights and loud noises unbearable. Your migraine might last a few hours or a few days. During that time, you might be in so much pain that you can't work or do any other activities.

The two main types of migraines are:

  • Migraine with aura
  • Migraine without aura

Migraine with aura means you see flashing lights or blind spots, or have some kind of muscle weakness before your migraine attack. Migraine without aura means that you don't get these cues beforehand. It's more common to have migraine without aura. About 14% of the world's population has migraine.

Most people who're prone to migraine get a painful attack once or twice a month. But if you have the condition known as chronic migraine, you get headaches much more often – 15 or more days a month for at least 3 months. 

Chronic migraine and episodic migraine have similar symptoms. The main difference is in the timing.

  •  Episodic migraine means your headaches happen up to 14 times a month. 
  • Chronic migraine means your headaches happen 15 times or more a month, with at least 8 days of migraine symptoms. 

Another difference is that chronic migraine tend to be more serious than episodic.

Episodic migraine can become chronic migraine, and chronic migraine can change back to episodic migraine. Studies show that 2.5% of people with episodic migraine developed chronic migraine within a year and that 26% of people with chronic migraine reverted to episodic migraine within 2 years.

 

 

If you have chronic migraines you don’t need to be told how painful it is. This isn't just a “bad” headache. People with migraine often go through four stages: prodrome, aura, attack, and postdrome. Here are the symptoms of chronic migraine, keeping in mind that not everyone goes through all the stages: 

Prodrome stage

A day or two before a migraine you might have:

  • Constipation
  • Food cravings
  • Neck stiffness
  • Mood changes
  • More frequent urination (peeing)
  • Increased yawning

Aura

Before or during a migraine headache, you might:

  • See flashing lights, colors, lines, or shadows
  • Lose vision
  • Get tingling face, hands, or feet
  • Lose strength
  • Become dizzy or have vertigo (feeling like you're spinning)

Attack

The headache can last 4-72 hours if not treated. During this time, you might have:

  • Bad throbbing pain on one or both sides of your head
  • Nausea
  • Vomiting
  • Extreme sensitivity to bright lights, sounds, touch, and smells 

Postdrome

You might find your chronic migraine stops suddenly or fades away slowly. For a day after an attack you might feel:

  • Drained
  • Fatigued, as if you had a hangover
  • Similar to how you felt in the prodrome stage; for instance, food cravings might return
  • Elated that the headache is over

Chronic migraine can take a toll on your personal life. If you get painful headaches for half of each month, you lose days of work or school and precious time with friends and family. It’s common for people with chronic migraines to also have depression.

It's not clear what causes migraines. Doctors are learning more about what brings on these chronic headaches, which often run in families. Some are the result of changes in your brain chemicals. Abnormal brain activity is also involved.

Every person who has migraine has different triggers, but common ones include a lack of sleep, caffeine, and being under stress. Others are flashing lights, loud sounds, strong smells, eating certain foods, food additives like the sweetener aspartame and the preservative MSG, and alcohol. Weather and low barometric pressure could also bring on a migraine attack.

Three times as many women as men get migraine. This may be because of hormone changes that happen around their monthly period, as well as during pregnancy and through menopause. Birth control can also play a role.

Taking care of yourself every day may prevent your migraine from turning into a long-term problem. For instance:

Catch some ZZZs

Not getting enough sleep can trigger a migraine episode. Aim for 7-8 hours of rest each night.

Watch your diet

While caffeine can soothe your pain, stopping it suddenly is a common cause of migraine. Other common food triggers include MSG (monosodium glutamate), aged cheeses, chocolate, nitrates in cured meats like hot dogs, artificial sweeteners, and alcohol.

Manage your stress

Tension and worry are common triggers. Try to carve out a few minutes each day to do something you love, or learn to breathe deeply when you’re having a crisis. You might join a support group or talk to a counselor.

Have a meal plan

Fasting and skipping meals can trigger headaches. Try to eat around the same times each day.

Get moving

Exercise is a good way to ease your anxiety and stress. It can also help you get to, and stay at, a healthy weight. Since obesity raises your risk of chronic migraines, getting in shape is crucial.

Know your triggers

Not all migraine attacks result from triggers. But one way to know whether you have triggers is to keep a headache diary. Each time you have an attack, write down details about what you were doing or eating, how long the headache lasted, and how you felt before it started. This will help you begin to notice patterns – and avoid your triggers. For instance, some people notice drinking coffee gives them a headache, while others feel it helps to take one away. 

Be careful with your medicine

If you have chronic migraine, you’re probably taking preventive medications. These are designed to make you get chronic migraines less often and to lessen their impact. They might include:

  • Blood pressure-lowering drugs
  • Antidepressants
  • Anti-seizure drugs
  • Botox shots
  • Calcitonin gene-related peptides (CGRP) monoclonal antibodies, newer drugs specially developed to prevent migraines

If you get a headache anyway, you might take some pain relievers as well. But too many can lead to a problem called medication overuse headache (MOH) where the drug that’s supposed to stop headaches starts to cause them. You could wind up with a dull, constant head pain every day.

You're at risk of medication overuse headaches if you take pain relievers for 15 days or more each month or take them along with other drugs at least 10 days out of the month.. If you think you’re having MOHs, talk to your doctor.

Both episodic migraine and chronic migraine can be treated with the same drugs. These include medicines that treat the pain and symptoms (like vomiting or nausea) as well as drugs that treat the causes of your migraine. In some cases, there are medical devices you can use to interrupt the headache. 

Treatments are divided into acute medicines (to end the migraine during an attack or keep it from getting worse) and preventive medicines (to prevent or lessen the number of migraines you have each month). The drugs below are acute medicines.

Over-the-counter migraine treatment

During a migraine attack, you can relieve your headaches with: 

  • Acetaminophen (Tylenol)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen (Motrin, Advil)
  • Naproxen (Aleve)

All these are available at your local drugstore without a prescription. An NSAID is a better choice than acetaminophen because it helps to relieve inflammation that can come with migraines. Some over-the-counter pain relievers are advertised as being made just for people with migraine. These usually include caffeine as an extra ingredient. 

Prescription medication for migraine

These are for use during an attack or when you feel one coming on and are available only by prescription. These drugs include:

Triptans. These are specially for treating migraine. They block pain pathways to the brain. You can take them as pills, nasal sprays or shots. Common triptans include rizatriptan (Maxalt) and sumatriptan (Imitrex). They often work better than over-the-counter drugs. But people with heart disease and high blood pressure might need to avoid them. 

Ergot alkaloids. These drugs are used for people who don't get relief from triptans or over-the-counter drugs. Dihydroergotamine (Ergomar, Migranal) can be given as a nasal spray or shot to relieve migraine headaches and other symptoms like sensitivity to light and sound. It has the side effect of possibly making your migraine-related nausea and vomiting worse. If you have heart disease, kidney disease, liver disease or high blood pressure, you probably can't take dihydroergotamine.

Gepants. These drugs relieve pain, nausea, and sensitivity to light and sound. They don't cause medication overuse headache and can be used by people with heart disease. Examples include rimegepant (Nurtec ODT) and ubrogepant (Ubrelvy). Gepants shouldn't be taken with some medicines used to treat cancer. 

Anti-emetics. These prescription medicines treat the nausea and vomiting you often get with migraine. Common anti-emetics include metoclopramide (Reglan) and prochlorperazine (Compazine, Compro). You usually take them along with your pain reliever. 

At-home migraine treatment

Here are some fast ways to lessen the symptoms of migraine:

Go into a dark room. Bright lights often trigger a migraine, so a dark environment can help lessen an attack.

Avoid noise. Loud noise is another migraine trigger for some people, so moving to a quiet place is helpful.

Move away from strong smells. Strong perfume, gasoline, and even pungent food smells can cause a migraine or worsen it.

Stay cool. Overheating can bring on migraines, so if you feel an attack is coming, turn on the AC or a fan to cool yourself down. 

Take a nap. Sleep not only helps prevent migraines, it can lessen their impact as well.

Apply a compress. Put a cloth soaked in cold water across your temples or neck. If that doesn't work, try a warm compress. Don't use either for longer than 15 minutes.

Have caffeine. Many people find a cup of coffee or tea, or a glass of cola brings some relief during a migraine episode. 

Homeopathic treatment for migraines

These alternative therapies may help with chronic migraine:

  • Ginger tea. It's been used for centuries to treat upset stomachs. Ginger candy or capsules may work too.
  • Acupuncture. A provider puts tiny needles into your skin at certain points. Studies show it may help headache pain.
  • Scalp massage. You or someone else massages the muscles around your scalp to relieve tension and stress, common headache triggers.
  • Herbs and supplements. Riboflavin (vitamin B2), magnesium, co-enzyme Q10, and the herb feverfew are all suggested to reduce and prevent headaches, though studies are mixed on whether they really work. Still, they're unlikely to hurt if you want to give them a try. Just let your doctor know in advance in case there might be an interaction with a medication. It may take 2 or 3 months to see any results, so be patient. Supplements seem more effective if you have episodic migraines rather than chronic migraines.
  • Relaxation techniques. Biofeedback, cognitive behavioral therapy, and meditation help prevent migraines in some people.
  • Aromatherapy. Though there's no scientific evidence for their use in migraine treatment, essential oils may relax and de-stress you, which could lessen your migraine. On the other hand, some people find strong smells bring on a headache, so proceed with caution.

When to seek medical attention

If you can’t stop throwing up or have a change in vision, get emergency medical care. You should also get checked out if a headache lasts more than 72 hours, is severe, or if you have any new symptoms that are frightening to you. These could include a stiff neck, double vision, or weakness in the body, all signs of a stroke.

Chronic migraine is a common type of headache where you feel a severe throbbing pain on one or both sides of your head, along with nausea, vomiting, and sensitivity to light and sound. For a migraine to be considered chronic, you must get it for at least 15 days in a month for at least 3 months. Chronic migraine can be triggered by stress, lack of sleep, loud sounds, flashing lights, and certain foods and drinks, among other things. Treatment involves pain relievers and anti-nausea medicine, plus home remedies like lying down in a quiet dark room and applying a compress. 

Are there any foods that may prevent chronic migraine? 

Everyone has different triggers for migraine, so there may not be any foods that prevent them for everyone. Some people find eating foods rich in magnesium, like leafy green veggies, nuts, and black beans, keeps migraines away. Foods with a lot of omega-3 fatty acids like salmon, mackerel, walnuts, chia seeds, and soybeans could help as well. Low-carb diets like Keto and Atkins have been shown to reduce migraine attacks. But most doctors feel the best thing you can do, food-wise, is just to eat a normal healthy diet and not skip meals.

Can chronic migraine be cured?

It can't be cured, but it can be eased. If you keep a headache diary and recognize your triggers, you can lessen the number of headaches you get. Also, taking medication will relieve the pain and prevent some headaches from returning. As you get older, you usually get fewer migraine episodes. 

Is there an age at which chronic migraine stops?

For many women with chronic migraine (and most of the people who get migraine are women), it tends to ease after age 50 and may even disappear. That's because women over 50 usually enter menopause, a time when they stop having periods and their bodies produce less of the female hormones estrogen and progesterone. Migraine is linked to female hormones.