As the name suggests, the problem with chronic migraines is that they continue over a long period of time. The name "transformed migraine" is also used since chronic migraines can evolve (or transform) from episodic to almost daily headaches. Symptoms may be mild, but migraines can occur in addition to the daily discomfort.
Risk Factors for Chronic Migraines
The most common risk factors for developing chronic or transformed migraines are obesity and frequent headaches. When considering other risk factors there are two different types to think about: those that can be modified and those that cannot. Modifiable risk factors include medication overuse, snoring, and stressful life events. Those that cannot be changed include female gender, low education/socioeconomic status, and head injury.
Symptoms of Chronic Migraines
The symptoms of a chronic migraine are the same as a "usual" migraine, including one-sided head pain that is usually described as "throbbing," pain worsening with normal activity, and pain that is considered moderate to severe. Also, you may experience nausea with or without vomiting, and light sensitivity (photophobia) or sound sensitivity (phonophobia). If you have chronic migraines you will have a headache more than 15 days out of the month for at least 3 months.
Treating Chronic Migraines
Both abortive and preventative treatments may be used in chronic migraines, often with the emphasis on prevention. Abortive medications are designed to stop the migraine once it has started. Those used in chronic migraines often include:
- Non-steroidal anti-inflammatory medications (NSAIDs). Ibuprofen (Motrin), Voltaren (diclofenac), etc.
- 5-HT receptor agonists ("Triptans"). sumatriptan (Imitrex), zolmitriptan (Zomig), etc.
There are four FDA-approved medications for migraine prevention: propranolol (Inderal), timolol (Blocadren), topiramate (Topamax) and divalproex sodium (Depakote).
Should one of these not work, your health care provider may choose to use a medication that is not formally approved for migraine prevention, but that has a good track record for its use. These medications include:
- Beta-blockers. Atenolol (Tenormin), long-acting metoprolol (Toprol XL), etc.
- Antidepressants. Amitriptyline, fluoxetine (Prozac), etc.
- Anticonvulsants. gabapentin (Neurontin), etc.
- Others. Lisinopril (Zestril), candesartan (Atacand), and verapamil (Calan) are among some of the choices.
In addition to medicines, reducing risk factors and triggers for migraines is an important strategy. Exercising regularly, eating meals on a schedule, and avoiding foods that frequently trigger headaches are a few things you can do.
Sources:
Maizels, Morris, M.D. "The Patient with Daily Headaches." Am Fam Physician 2004;70:2299-306, 2313-4.
Scher AI, Stewart WF, Ricci JA, Lipton RB. Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain. 2003;106:81-9.
Spierings EL, Schroevers M, Honkoop PC, Sorbi M. Presentation of chronic daily headache: a clinical study. Headache. 1998;38:191-6.
