What is a Chronic Migraine?

The National Library of Medicine describes Chronic Migraine Cas a condition characterized by the experience of migrainous headache on at least 15 days per month, is highly disabling. Patients with chronic migraine present to primary care, are often referred for management to secondary care, and make up a large proportion of patients in specialist headache clinics.

When assessing a patient with chronic headaches (that is, by definition, headaches on at least 15 days per month), it is important from the outset to ascertain how the headaches originally developed. There are two typical patterns. In one set of cases, patients with a pre-existing primary headache disorder (usually, but not exclusively migraine) have ever-increasing attacks until they reach a stage where they do not recover headache freedom in between, a pattern originally called ‘transformed migraine’.

There are three broad approaches to treating chronic migraine: lifestyle and trigger management, acute treatments (i.e. those taken during attacks or exacerbations of chronic pain), and preventive treatments (medication or other interventions designed to reduce the tendency to have attacks). While many patients find that lifestyle adjustments such as regularizing meals and sleep can reduce the frequency of their attacks, some form of medication or other treatment is almost invariably necessary in patients with chronic migraine. The National Institute for Health and Care Excellence (NICE) have recently published guidance on the diagnosis and treatment of migraine, and further consensus guidelines have been published by the British Association for the Study of Headache, the American Headache Society and American Academy of Neurology, and the European Headache Federation