What are the symptoms?
Chronic migraine symptoms are the same as those of episodic migraines. Chronic migraines simply last longer or happen more often. Chronic migraine also involves headaches.
To receive this diagnosis, you must have:
- At least 15 days in a month where you experience a headache or migraine. This must happen for at least three months.
- At least eight days per month where your headaches include migraine symptoms or features. This must happen for at least three months.
Migraines symptoms
As mentioned, migraines aren’t the same as headaches, and they can take different forms. The symptoms you experience from migraine to migraine can also vary. Migraines happen in up to four stages (but not every migraine involves all four):
- Prodrome: This is a pre-migraine stage. You can often feel subtle differences that hint that a migraine is forthcoming.
- Aura: These are symptoms that happen as a migraine disrupts different areas of your brain.
- Headache: This is the pain stage of a migraine.
- Postdrome: This is when you feel the aftereffects of a migraine. A common way to describe it is like a “migraine hangover.”
With chronic migraine, your symptoms must meet the following criteria:
Migraine without aura (must last between four hours and 72 hours)
A headache phase that meets at least two of the following criteria:
- Pain on one side (left or right) of your head.
- Pain that has a pulsing or pounding feel.
- Pain that’s moderate or severe.
- Pain that worsens with even basic levels of activity (such as walking or using stairs) or makes you avoid activity.
A headache phase that involves at least one of the following:
- Nausea.
- Vomiting.
- Both light sensitivity (photophobia) and sound sensitivity (phonophobia).
Migraine with aura
One or more of the following types of aura symptoms:
- Visual (flashing lights, haze, zig-zag-like areas around the center of your vision or other vision changes).
- Touch (tingling or numbness).
- Speech/language (difficulty speaking or understanding what others say).
- Motor (hemiplegia, which is one-sided weakness or paralysis, affecting your body and/or face).
- Brainstem (loss of coordination, balance issues, vertigo, tinnitus or digestive problems like diarrhea or constipation).
- Retinal (one-sided blindness, either partial or total, or shimmering areas).
At least three of the following criteria:
- At least one aura symptom spreads gradually over five minutes or longer.
- Two or more aura symptoms in succession.
- Each aura symptom lasts between five minutes and one hour.
- At least one aura symptom is one-sided.
- At least one aura symptom with positive symptoms (“good” means the symptoms add an effect; negative symptoms cause you to partly or completely lose the affected ability).
- A headache phase that occurs at the same time or within 60 minutes after an aura.
What causes the condition?
Migraines can be genetic, meaning you’re more likely to have migraines if you have a close biological relative, especially a parent or grandparent, with this condition.
Researchers also suspect several processes could contribute to migraines, including:
- Blood flow changes in your brain because of a widening or narrowing of blood vessels.
- Temporary changes that make it harder for brain cells to conduct electrical signals.
- Brain chemistry changes, including shifts in levels of neurotransmitters like serotonin.
- Incorrect signaling from nerve clusters around your eyes or elsewhere on your head.
- Malfunctions in pain/signal processing centers in different areas of your brain.
- Changes in how your body processes and feels pain because of the effects of chronic pain.
Risk factors
Several factors increase your risk of developing chronic migraine or contribute to making it worse. These include having:
- Obesity.
- Head injuries like concussions.
- Other chronic conditions, especially pain-related conditions like fibromyalgia.
- Mental health conditions like depression or anxiety.
- Sleep disorders, especially sleep apnea.
Migraine transformation
Episodic migraines can sometimes “transform” into chronic migraine. That often happens because of processes that experts still don’t fully understand. There’s evidence that overuse of certain migraine treatments is a possible contributor to this transformation. The term “overuse” here doesn’t automatically refer to a substance use disorder, and it can happen even with medications that aren’t habit-forming.
Because of the risk of transformation, experts strongly recommend against frequent use of certain medications if you have episodic migraine. Medication overuse can also act as a trigger in some cases.
Triggers
Foods, substances, smells, sounds or other environmental factors or circ*mstances can trigger the start of a migraine, typically within hours or days.
The most common triggers include:
- Stress or anxiety.
- Hormone changes related to menstruation.
- Hunger or dehydration.
- Barometric pressure changes (such as those that happen with weather changes).
- Sleeping too much or not enough.
- Certain scents, fragrances or odors.
- Certain foods or food additives (aged cheeses, red wines, chocolate and aged or preserved meats are some of the most common examples).
- Light (certain types of lighting, or an intense reflection or glare off a reflective surface — even for a fraction of a second — pointed directly at one or both eyes can trigger a migraine).
- Caffeine (especially having too much or less than your usual amount).
- Certain sounds, especially low-frequency sounds like jackhammering or high-frequency sounds like power tools.
- Frequent headache medication use (these are known as medication overuse headaches or “rebound” headaches).
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What are the possible complications of chronic migraine?
Complications of migraines are possible but uncommon. They include:
- Status migrainosus (a severe migraine that lasts at least three days).
- Strokes.
- Aura-related seizures.
- Heart attacks (very rare).
