5 Effective Chronic Migraine Treatments

Living with chronic migraines can be a daily struggle, affecting every aspect of our lives. We understand the challenges of managing this condition, which often includes sensitivity to light and the constant search for migraine relief. As someone who has experienced the debilitating effects of chronic migraines, I’ve made it my mission to explore the best treatments for chronic migraine and share this knowledge with others who are seeking help.

In this comprehensive guide, we’ll dive into the world of chronic migraine treatments, covering both preventive treatments and migraine medication options. We’ll explore the latest advancements in migraine relief and discuss how to find the most effective solutions for your unique situation. By the end of this article, you’ll have a better understanding of the available options and be better equipped to work with your healthcare provider to manage your chronic migraines.

Understanding Chronic Migraine

Definition and Prevalence

Chronic migraine is a condition where we experience frequent or long-lasting episodes of headaches and migraines. To receive this diagnosis, we must have at least 15 days in a month where we experience a headache or migraine, with at least eight of those days including migraine symptoms. This pattern must persist for at least three months.

The prevalence of chronic migraine is relatively low compared to episodic migraine. Worldwide, about 1% to 2.2% of people have chronic migraine. It’s more common in women and people assigned female at birth, affecting between 1.7% and 4% of this group, compared to 0.6% to 0.7% of men and people assigned male at birth.

Chronic migraine represents about 7.7% of the total migraine population. The condition is most prevalent among individuals in their forties, with the highest rates seen in women (1.9%) and men (0.8%) aged 40 to 49 years.

Symptoms and Characteristics

The symptoms of chronic migraine are similar to those of episodic migraines, but they occur more frequently or last longer. Migraines typically progress through four stages, although not every migraine involves all four:

1. Prodrome: This pre-migraine stage often includes subtle changes that hint at an upcoming migraine.
2. Aura: These are symptoms that occur as the migraine disrupts different areas of our brain, such as visual disturbances or numbness.
3. Headache: This is the pain stage of a migraine, often described as a throbbing pain on one side of the head.
4. Postdrome: This is when we feel the aftereffects of a migraine, sometimes referred to as a “migraine hangover.”

Chronic migraines can have a significant impact on our daily lives. The symptoms are often severe enough to disrupt our routine and activities. We may experience sensitivity to light, which can make it challenging to work or engage in social activities. Other common symptoms include nausea, vomiting, and dizziness.

It’s important to note that the duration of headache attacks tends to be longer in chronic migraine compared to episodic migraine. On average, treated attacks last about 24.1 hours for chronic migraineurs, compared to 12.8 hours for those with episodic migraine. Untreated attacks can last even longer, averaging 65.1 hours for chronic migraineurs.

Differentiating from Episodic Migraine

The main difference between chronic and episodic migraine lies in the frequency of headache days. Episodic migraine is characterised by 0 to 14 headache days per month, while chronic migraine involves 15 or more headache days per month.

However, it’s crucial to understand that the boundary between chronic and episodic migraine isn’t always clear-cut. Recent research has shown that the degree of disability experienced by those with 8 to 14 migraine days per month is similar to those with 15 to 23 migraine days per month. The greatest disability is seen in those with 24 or more headache days per month.

The relationship between episodic and chronic migraine is complex. Episodic migraine can progress to chronic migraine at a rate of about 2.5% per year. Conversely, chronic migraine can revert to episodic migraine, with a two-year transition rate of 26%.

It’s worth noting that while the frequency of headaches differs, the characteristics of individual migraine attacks are the same in both chronic and episodic migraine. The key distinction is that those with chronic migraine have fewer headache-free days, which can significantly impact their quality of life and increase the need for effective chronic migraine treatments.

Diagnosing Chronic Migraine

Medical History and Physical Examination

To diagnose chronic migraine, we start with a thorough medical history and physical examination. This process is crucial to understand the nature of the headaches and rule out other potential causes. We ask detailed questions about the frequency, duration, and characteristics of the headaches. It’s essential to provide information on how often the headaches occur, how long they last, and what other symptoms accompany them.

We also inquire about the impact of headaches on daily activities and any family history of migraines. Keeping a migraine diary can be incredibly helpful in this process. It allows us to track the pattern of headaches, potential triggers, and the effectiveness of any treatments tried.

During the physical examination, we conduct a necessary neurological assessment.

This includes checking for any signs of neurological deficits or abnormalities that might suggest a secondary cause for the headaches. We pay close attention to any changes in the pattern of headaches or the development of unusual symptoms, as these could indicate a need for further investigation.

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Diagnostic Criteria

To receive a diagnosis of chronic migraine, specific criteria must be met. According to the International Classification of Headache Disorders (ICHD-3), chronic migraine is defined as headaches occurring on 15 or more days per month for more than three months. At least eight of these headache days must meet the criteria for migraine or respond to migraine-specific treatment.

The diagnostic criteria for migraine include at least two of the following characteristics: unilateral location, pulsating quality, moderate to severe pain intensity, and aggravation by routine physical activity. Additionally, during the headache, there must be at least one of the following: nausea and/or vomiting, or sensitivity to light and sound.

It’s important to note that chronic migraine often coexists with other types of headaches, such as tension-type headaches. Identifying these different headache types is crucial for appropriate treatment.

Ruling Out Secondary Causes

While chronic migraine is a primary headache disorder, it’s essential to rule out secondary causes of headaches. Secondary headaches are those caused by underlying conditions, and they account for about 18% of all headaches. To identify potential secondary causes, we look for red flags in the patient’s history and examination.

Some red flags that warrant further investigation include:

1. Sudden onset of severe headache
2. New headache in patients over 50 years old
3. Progressive worsening of headaches
4. Headaches associated with systemic symptoms like fever or weight loss
5. Neurological symptoms or signs
6. Headaches that change with posture

If any of these red flags are present, we may recommend additional tests to rule out secondary causes. These tests might include neuroimaging studies such as MRI or CT scans. An MRI scan uses magnetic fields and radio waves to produce detailed images of the brain and blood vessels, while a CT scan uses X-rays to create cross-sectional images of the brain.

It’s important to remember that most headaches, including chronic migraines, are not life-threatening. However, proper diagnosis is crucial to ensure appropriate treatment and to rule out any serious underlying conditions. By following these diagnostic steps and criteria, we can accurately diagnose chronic migraine and develop an effective treatment plan to provide migraine relief and improve quality of life for those suffering from this condition.

Pharmacological Treatments

Chronic migraine treatments often involve a combination of preventive and acute medications to manage symptoms and reduce the frequency of attacks. We’ll explore the various options available to help those of us struggling with this debilitating condition.

Preventive Medications

Preventive medicines, also known as prophylactics, are taken daily to decrease the frequency, severity, and duration of migraine attacks. We typically consider these medications for individuals experiencing at least four migraine attacks per month or eight headache days in a month.

There are several categories of preventive medications available for chronic migraine treatments:

1. Beta-blockers: Propranolol is one of the most common and effective first-line medications for migraine prevention. It may take up to 12 weeks at an adequate dose for therapeutic benefits to become apparent. Other beta-blockers like timolol, atenolol, and metoprolol can also be used.
2. Anti-convulsants: Topiramate and sodium valproate are two anticonvulsant drugs used as first-line agents for migraine prevention. Topiramate has shown comparable efficacy to propranolol in preventing migraine headaches.
3. Antidepressants: Amitriptyline has been shown to be beneficial in migraine prevention. Other antidepressants like venlafaxine and fluoxetine have also been used for migraine prophylaxis.
4. Calcitonin gene-related peptide (CGRP) monoclonal antibodies: These are newer medications specifically developed for migraine prevention. Examples include erenumab, fremanezumab, galcanezumab, and eptinezumab.
5. Angiotensin II blockers: Candesartan, typically used for hypertension treatment, can help reduce migraine frequency.

When starting preventive treatment, we usually begin with a low dose and gradually increase it. It’s important to note that it can take six to eight weeks to see any impact from the medication, and ideally, we should take a preventive for three months to assess its effectiveness.

Acute Medications

Acute medications, also known as abortive treatments, are taken during migraine attacks to stop symptoms. These drugs work best when taken at the first sign of an oncoming migraine. Some common acute medications include:

1. Pain relievers: Over-the-counter or prescription pain relievers like aspirin or ibuprofen can provide relief for mild to moderate migraines.
2. Triptans: These prescription drugs, such as sumatriptan and rizatriptan, are specifically designed to treat migraines by blocking pain pathways in the brain.
3. Dihydroergotamine: Available as a nasal spray or injection, this drug is most effective when taken shortly after migraine symptoms start.
4. Gepants: These newer oral medications, like ubrogepant and rimegepant, have shown effectiveness in relieving pain and other migraine symptoms.
5. Anti-nausea drugs: Medications like chlorpromazine or metoclopramide can help if migraines are accompanied by nausea and vomiting.

It’s crucial to be cautious about medication overuse, as taking acute treatments too frequently can lead to medication overuse headaches. We should aim to use rescue medication on no more than two days per week on average to prevent this issue.

Botox Injections

Botox (botulinum toxin type A) injections have been approved for use in chronic migraine treatment. This treatment involves a series of small injections around the head and neck every 12 weeks. Botox is typically considered for individuals who have not responded to at least three other preventive treatments.

The exact mechanism of how Botox works for migraines isn’t fully understood, but it’s thought to block chemicals called neurotransmitters that carry pain signals from the brain. Most people need at least two treatment cycles to determine if Botox is effective for them. A good response is usually considered a 30-50% reduction in headache frequency.

Pharmacological treatments for chronic migraine offer a range of options to help manage this condition. By working closely with our healthcare providers, we can find the most effective combination of preventive and acute medications to reduce the impact of migraines on our daily lives and improve our overall quality of life.

Conclusion

Chronic migraines can have a significant impact on our daily lives, but there are many treatment options available to manage this condition. From preventive medications and acute treatments to lifestyle changes and alternative therapies, we have a range of tools to help reduce the frequency and severity of migraine attacks. By working closely with healthcare providers and staying informed about the latest advancements in migraine relief, we can develop a personalised treatment plan that works best for our individual needs.

While managing chronic migraines can be challenging, it’s important to remember that we’re not alone in this journey. Support from loved ones and healthcare professionals can make a big difference in our ability to cope with this condition. At Inquire Talk, we understand the importance of mental health in fostering healthy relationships, and our team of compassionate therapists offers online counselling, therapy, and psychotherapy services to support individuals in their journey towards healthier and happier relationships. With the right approach and support, we can improve our quality of life and find effective ways to manage chronic migraines.

Here are few certified therapists who you can get in touch and book a therapy session with:

Wenna Chen

Marcelo Matias

John Hilsdon