How to deal with chronic migraines
Reviewed by our clinical team
Migraines are a type of debilitating neurological condition that can seriously affect many aspects of daily life, often manifesting as severe headaches, nausea, and sensitivity to light and sound. Chronic, in particular, can be difficult to manage and can cause daily discomfort.
In this article, we’ll explore the symptoms of chronic migraines, the triggers behind them, and the best treatment options available. We’ll also answer some frequently asked questions about chronic migraines and hopefully guide you to the right treatment for you.
What is chronic migraine?
Chronic migraines, are a type of migraine that occurs on 15 or more days per month. This is in contrast to episodic migraines, which occur 14 days or fewer per month. It’s thought that around 1 in 1000 people experience chronic migraines in the UK.
Chronic migraines can be debilitating, not only physically, but emotionally and socially, impacting every aspect of daily life. Chronic migraines are a serious medical condition, so if you’re experiencing migraines daily or very regularly, you should speak to a doctor as soon as possible.
Migraine causes
There are a number of common migraine triggers, including:
Genetics
Migraines can run in families, so there’s likely a genetic link. This isn't so much a trigger but instead a possible underlying cause.
Hormonal changes
Fluctuations in oestrogen levels, particularly in women, can trigger migraines. This is why many women experience migraines around their period. These are called menstrual migraines, and it’s thought that around 50-60% women notice a link between their migraine and periods. This may not be apparent until a woman reaches her late thirties or into her forties, even for those who may have suffered migraine from a younger age.
Environmental factors
Certain environmental triggers such as changes in weather, bright or flashing lights, and loud noises can trigger migraines. This is thought to be related to the way changes in pressure or other sensory input affect the nervous system.
Stress
Stress is a common trigger for migraines. Everything from work, relationships, and finances can contribute to raised stress levels, which can in turn cause tension in the neck, back, and head, triggering headaches.
Medications
Certain medications, such as birth control pills, can trigger migraines in some people. If you’re experiencing migraines and are taking one of these types of medications, speak to your doctor about an alternative.
Diet
Certain foods and drinks can also potentially trigger migraines, including alcohol, caffeine, processed foods, and artificial sweeteners. Dehydration can also be a factor.
It's worth noting that not everyone will have the same triggers, as they can vary from person to person. Identifying your own triggers is a crucial part of preventing and controlling migraines through diet, lifestyle, or other changes.
What causes chronic migraines?
Chronic migraines tend to come on gradually, with people getting more frequent migraines over a period of time. Around 2.5% of people who have episodic migraines will develop chronic migraines, but it’s not fully known why some people get chronic migraines. But there are some things that might make you more susceptible to them, these include:
- Depression and anxiety
- Sleep apnoea
- Pain conditions like fibromyalgia
- Postural orthostatic tachycardia syndrome (an abnormal heart increase in heart rate when you sit or stand up)
People who have chronic migraines are also likely to overuse medication, which can in turn cause headaches. These are known as medication overuse headaches. So this is another factor that might contribute to chronic pain.
Chronic migraine symptoms
The symptoms of chronic migraines can vary from person to person, but the most commonly reported migraine symptoms are:
Frequent headaches
Chronic migraines are characterised by frequent and recurring headaches, often lasting for several days at a time. These headaches can be debilitating and can significantly impact a person's quality of life.
Sensitivity to light and sound
Sensitivity to light (photophobia) and sensitivity to sound (phonophobia) are common symptoms of chronic migraines. These are very severe symptoms that can make it difficult to perform daily activities or even leave the house.
Nausea and vomiting
Nausea and vomiting are common with migraines, and can be especially severe in individuals who experience chronic migraines. These symptoms can make it difficult to eat or keep food down, exacerbating the debilitating nature of chronic migraines.
Fatigue and drowsiness
Chronic migraines can also cause fatigue and drowsiness, making it difficult for those who experience them to stay alert and focused throughout the day. This can further impact a person's ability to work or perform daily tasks.
Visual disturbances
Some individuals with chronic migraines may experience visual disturbances, such as blind spots, zigzag lines, or flashing lights. These symptoms are known as an aura and can occur before or during a migraine attack. Not everyone experiences migraine with aura, so always speak to a doctor if you’re unsure.
Impact of chronic migraine
Chronic migraines can have a significant impact on a person's physical and mental well-being. Physically, chronic migraines can cause frequent headaches, sensitivity to light and sound, nausea, and fatigue. These symptoms can make it difficult for individuals to carry out daily activities, leading to reduced productivity and an overall decrease in quality of life.
Mentally, chronic migraines can cause depression and anxiety and can lead to feelings of isolation and frustration. Individuals may feel like they are not being believed or understood by those around them, which can be emotionally draining.
It's important to note that chronic migraines can also become so severe when left untreated that they become disabling, making it difficult or even impossible for individuals to work or perform basic activities. If you are experiencing chronic migraines, it's important to seek help from a healthcare professional to develop a treatment plan as soon as possible. There are also many support groups and online resources available to help individuals cope with the impact of chronic migraines.
Diagnosing chronic migraine
Diagnosing chronic migraines can be a complex process, as it involves identifying the specific type of migraine, as well as the frequency and severity of the headaches, but don’t let that put you off getting help.
To diagnose chronic migraines, your doctor will typically conduct a physical examination, including a detailed headache history, to determine whether you are experiencing chronic or episodic migraines. They may also order what are called imaging tests, such as a CT scan or MRI, to rule out any underlying medical conditions that may be causing the headaches.
If you are experiencing chronic migraines, it is important to see a doctor as soon as possible to receive an accurate diagnosis and appropriate treatment. If you aren’t currently able to go outside due to your migraine, you can speak to one of our online GPs.
Chronic migraine treatment
There’s no need to tackle chronic migraines alone, your doctor can help find the best course of treatment and help get you back on your feet. You might be given treatment to relieve migraine symptoms when you get them, or as chronic migraines are so frequent you might be given treatment to prevent migraines.
Acute treatment (migraine relief)
If you’re experiencing a lot of migraines, it can be hard to know when to take migraine relief and not run the risk of getting a medication overuse headache. But if you can single out the days you feel better or worse, you can use migraine treatments on the days your symptoms are worse.
Commonly people take over-the-counter painkillers (like paracetamol and ibuprofen), triptans (like Sumatriptan or Rizatriptan) or you can also take a medication called Vydura. You might also want to take antiemetics (anti-sickness treatments) if you’re experiencing nausea.
Preventative treatment
If you have chronic migraines, you might have more days in a month affected than days that are clear. So, you might be eligible for preventative treatment. There are a few different options available in the UK, including beta-blockers, tricyclic antidepressants, anti-epilepsy drugs and the blood pressure tablet candesartan.
Vydura can also be taken as a preventative treatment, it can be taken every other day to prevent migraines.
If you visit a headache specialist, they might also look at less common treatment options, like botox, monthly antibody injections and a nerve blocking injection.
Conclusion
Chronic migraines can severely impact an individual's physical and mental well-being and damage quality of life. Although these types of migraine are very serious, treatments are available, and there’s no need to do it alone.
If you are experiencing chronic migraines, it is important to take action to manage them, starting with identifying triggers so you can better avoid them. It’s crucial that you talk to your doctor to rule out underlying conditions and discuss potential treatment options, such as medication or preventative therapy, to minimise the impact your migraines have on your life.
For more information on dealing with chronic migraines, visit our migraine support section.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416971/
https://www.nice.org.uk/guidance/ta260/documents/migraine-chronic-botulinum-toxin-type-a-final-scope2
https://migrainetrust.org/understand-migraine/genetics-and-migraine/
https://www.nhs.uk/conditions/headaches/10-headache-triggers/
https://migrainetrust.org/understand-migraine/types-of-migraine/chronic-migraine/
https://www.nationalmigrainecentre.org.uk/understanding-migraine/factsheets-and-resources/menstrual-migraine/
https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/migraine
https://www.nhs.uk/conditions/postural-tachycardia-syndrome/
https://cks.nice.org.uk/topics/migraine/diagnosis/diagnosis/
https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/high-cost-drug-policies-and-pro-formas/migraine/3803-migraine-pathway-chronic/file
