About Chronic Migraines
Migraines occur when blood vessels in the head contract and expand (narrow and widen) abnormally. This causes inflammation and pain. Factors related to abnormal blood vessel contraction and expansion may include metabolism, stress, and genetic factors.
Non-modifiable risk factors (factors a person cannot change or control) for chronic migraine include:
- Age: The risk of developing chronic migraine tends to increase with age.
- Women: Women are more likely to experience chronic migraine than men.
Modifiable risk factors (factors a person potentially can change or control) for chronic migraine include:
- Obesity: Being overweight or obese has been associated with an increased risk of migraines.
- Stress: High levels of stress can contribute to the development and persistence) of migraines.
- Medication overuse: Overusing acute migraine medications can lead to an increased risk of chronic migraine.
It's important to note that having one or more risk factors does not guarantee that a person will develop chronic migraine, and individuals without apparent risk factors can still develop the condition. It's always best to consult with a healthcare professional for personalized advice and management strategies.
Common symptoms of chronic migraine include fatigue, mood changes, and neck stiffness. These symptoms are often experienced before the onset of a migraine attack. Other symptoms include:
- Nausea
- Sensitivity to light, smells, and noise
- Dizziness
- Sensory disturbances (aura) that can include visual disturbances like flashing lights or blind spots in the vision field
- Trouble thinking or speaking
- Numbness or tingling
It's important to note that chronic migraine is more than just a headache and can have disabling effects on daily life. If you are experiencing these symptoms, it is recommended to consult with your healthcare professional for an accurate diagnosis and appropriate management strategies.
To diagnose chronic migraine, doctors typically perform the following examinations, tests, and procedures:
- Medical history assessment: Doctors will review your medical history and ask about your symptoms, including the frequency, duration, and intensity of your headaches.
- Physical examination: A thorough physical examination will be conducted to check for any abnormalities in reflexes, strength, and coordination.
- Neurological examination: This examination focuses on assessing the nervous system for any signs of dysfunction or abnormalities.
- Blood tests: Blood tests may be done to check for signs of infection, inflammation, electrolyte imbalances, or other systemic issues that could contribute to the headaches.
- Imaging studies: In some cases, doctors may order imaging tests such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan to rule out other severe conditions like bleeding in the brain, injury, or structural abnormalities.
To determine the severity of chronic migraine, additional examinations, tests, and procedures may include:
- Headache diary: Keeping a detailed record of your headaches can help identify patterns and triggers that may contribute to the severity of your migraines.
- Electroencephalogram (EEG): This test measures the electrical activity in your brain and can help identify any abnormal brain wave patterns associated with migraines.
- Trigger testing: Identifying specific triggers that worsen your migraines through controlled exposure can help determine their impact on the severity of your condition.
- Pain scale assessment: Doctors may use pain scales to assess the intensity and severity of your headaches during different episodes.
It's important to note that these are general examinations, tests, and procedures used in diagnosing and assessing chronic migraine. Your doctor will determine which specific tests are necessary based on your individual symptoms and medical history. Always consult with your healthcare professional for personalized advice.
The goals of treatment for chronic migraine are to:
- Relieve pain and restore function
- Reduce the frequency of migraine attacks
- Prevent complications
- Manage any existing comorbidities
To achieve these goals, various treatment options are available:
- Acute therapies: These medications aim to provide immediate pain relief during a migraine attack. They include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Triptans
- Ergot alkaloids
- Ditans
- Gepant calcitonin gene-related peptide (CGRP) inhibitors
- Antinausea medications
- Preventive treatments: These medications are taken regularly to reduce the frequency and severity of migraine attacks. They may include
- Beta-blockers
- Antidepressants
- Calcium channel blockers
- CGRP inhibitors, including monoclonal antibody and gepant CGRPs
- Anticonvulsants
- Botulinum toxin injections
- Occipital nerve blocks: A healthcare provider may inject an anesthetic near a nerve at the back of the head to block pain signs and provide temporary pain relief.
- Nerve stimulation devices (neuromodulation devices): These are devices that apply electrical pulses to nerves to help prevent, reduce, or stop headache attacks.
- Health behavior changes:
- Keeping a food log: Tracking foods or beverages that may trigger migraines can help identify potential triggers.
- Risk factor modification: Identifying triggers and making lifestyle changes like improving sleep quality, managing stress, and avoiding environmental triggers (such as bright lights or strong odors) can help manage chronic migraines.
It is important to note that treatment decisions should be based on the individual's specific condition and preferences. Consulting with a healthcare professional is recommended to determine the most appropriate treatment plan for each person. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.