Chronic Migraine: Symptoms, Causes, Treatment

What are the symptoms of chronic migraine?

Chronic migraine is characterized by headaches that occur on 15 or more days per month for at least three months, with at least eight of those headaches having features of migraine. The symptoms of chronic migraine can be debilitating and significantly impact daily life. Common symptoms include:

1. Headache Pain: Typically, the headache is severe and throbbing or pulsating, often on one side of the head, but it can occur on both sides. The pain can last from 4 hours to several days.
2. Nausea and Vomiting: Many people with chronic migraine experience nausea and, in some cases, vomiting.
3. Sensitivity to Light (Photophobia): Bright lights can exacerbate the headache pain, making it necessary to rest in a dark room.
4. Sensitivity to Sound (Phonophobia): Loud noises can intensify the headache pain.
5. Sensitivity to Smells (Osmophobia): Certain smells can trigger or worsen a migraine attack.
6. Aura: Some individuals experience auras before or during a migraine. Auras can include visual disturbances such as seeing flashing lights, zigzag lines, or blind spots. Auras can also involve sensory, motor, or speech disturbances.
7. Neck Pain or Stiffness: Pain or stiffness in the neck can be a common accompanying symptom.
8. Fatigue: Chronic migraines can lead to significant fatigue, both during and between attacks.
9. Dizziness or Vertigo: Some individuals experience a sensation of spinning or dizziness.
10. Mood Changes: Mood swings, including feelings of depression, irritability, or anxiety, can be associated with chronic migraine.
11. Cognitive Difficulties: Problems with concentration, memory, and thinking clearly are often reported.
12. Sleep Disturbances: Difficulty falling asleep, staying asleep, or experiencing restful sleep can be common.
13. Other Symptoms: Some people may experience additional symptoms such as facial pain, numbness or tingling, and gastrointestinal disturbances.

Chronic migraines can vary greatly in their presentation and severity from person to person. If you suspect you have chronic migraine, it’s important to seek medical advice for proper diagnosis and treatment.

What are the causes of chronic migraine?

The exact cause of chronic migraine is not fully understood, but it is believed to involve a combination of genetic, environmental, and neurological factors. Several triggers and risk factors have been identified that may contribute to the development of chronic migraine. These include:

1. Genetics: A family history of migraine or other types of headaches can increase the risk of developing chronic migraine.
2. Neurological Factors: Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, may play a role in migraine attacks. Imbalances in brain chemicals such as serotonin, which helps regulate pain in your nervous system, may also be involved.
3. Hormonal Changes: Fluctuations in estrogen levels, such as those experienced during menstruation, pregnancy, or menopause, can trigger migraines in some individuals.
4. Triggers: Certain factors or triggers can provoke migraine attacks in susceptible individuals. Common triggers include stress, certain foods (such as aged cheeses, processed meats, and foods containing MSG), alcohol (especially red wine), caffeine, sensory stimuli (such as bright lights or strong smells), changes in sleep patterns, and physical exertion.
5. Medications: Overuse or rebound use of certain medications, including over-the-counter pain relievers and prescription migraine medications, can lead to chronic migraine.
6. Other Health Conditions: Chronic migraine may occur as a complication of other health conditions, such as depression, anxiety, sleep disorders, and chronic pain conditions.
7. Environmental Factors: Environmental factors such as weather changes, high altitude, or barometric pressure changes can trigger migraines in some individuals.
8. Lifestyle Factors: Poor diet, inadequate hydration, irregular meal times, and lack of physical activity can also contribute to the development of chronic migraine.

It’s important to note that not everyone with chronic migraine will have identifiable triggers, and triggers can vary widely among individuals. Identifying and avoiding triggers, along with appropriate medical treatment and lifestyle modifications, can help manage chronic migraine and reduce the frequency and severity of attacks.

What is the treatment for chronic migraines?

Chronic migraines are a type of headache disorder that can be challenging to treat, but there are several effective treatment options available. The goal of treatment is to reduce the frequency and severity of migraine attacks, as well as to alleviate symptoms such as pain, sensitivity to light and sound, and nausea. Here are some common treatment options for chronic migraines:

1. Medications:
   • Triptans: These medications are commonly used to treat acute migraines, but they can also be prescribed for chronic migraines.
   • Ergotamines: These medications work by constricting blood vessels in the brain.
   • Anti-inflammatory medications: Corticosteroids, such as prednisone, can be prescribed to reduce inflammation and swelling in the brain.
   • Anticonvulsants: Medications like valproate and topiramate can be used to prevent migraines.
   • Beta blockers: These medications can help reduce the frequency and severity of migraines.
2. Preventive medications:
   • Topiramate: This medication is commonly used to prevent migraines and is often prescribed in combination with other medications.
   • Valproate: This medication is also used to prevent migraines and can be effective in reducing the frequency and severity of attacks.
   • OnabotulinumtoxinA (Botox): This medication is injected into specific areas of the head and neck to prevent migraines.
3. Alternative therapies:
   • Acupuncture: This ancient Chinese practice involves inserting thin needles into specific points on the body to stimulate healing and relaxation.
   • Chiropractic care: Chiropractors use spinal manipulation and other techniques to help relieve tension and pressure in the neck and head that may contribute to migraines.
   • Massage therapy: Massage can help reduce stress and tension, which can contribute to migraines.
   • Relaxation techniques: Techniques like meditation, deep breathing, and progressive muscle relaxation can help reduce stress and alleviate migraine symptoms.
4. Lifestyle changes:
   • Maintaining a healthy lifestyle: Getting regular exercise, eating a balanced diet, and getting enough sleep can help reduce migraine frequency and severity.
   • Stress management: Finding ways to manage stress, such as through yoga or meditation, can help reduce migraine frequency and severity.
   • Keeping a headache diary: Tracking migraine symptoms and triggers can help identify patterns and make it easier to develop a personalized treatment plan.
5. Surgical interventions:
   • Microvascular decompression: This surgery involves freeing compressed nerves that may be contributing to migraines.
   • Occipital nerve block: This procedure involves injecting medication into the occipital nerve to reduce pain and inflammation.

It’s important to note that each person’s experience with chronic migraines is unique, and what works for one person may not work for another. It’s often necessary to try several different treatment options before finding the right combination of therapies that work effectively.