Chapter 3, Episode 1: Transition from Episodic to Chronic Migraine


This content has been medically reviewed by Dr. Sarah Ahmad.

Experts classify a person’s migraine diagnosis in many ways, including by the frequency of attacks. 

The term “episodic migraine” means that a person with migraine has fewer than fifteen headache days per month. 

The term “chronic migraine” means that a person has fifteen or more headache days per month, for at least three months. Eight or more of those headache days should have migraine symptoms like nausea and/or sensitivity to light, sound, smell, or movement

Still, this distinction is being questioned given new data that suggests people with at least 8 or more headache days per month may be as disabled as those with 15 or more headache days per month.

About two to three percent of people with episodic migraine progress to chronic migraine each year. 

Experts don’t understand all of the reasons this can happen but some risk factors have been identified.  

These include female sex, having frequent migraine attacks, headaches that do not respond well to treatments, obesity, major life events including trauma, low socioeconomic status, and caffeine misuse.

Another risk factor is frequent use of both over-the-counter and prescription abortive medications, which are taken to try to stop an attack. Some medications such as opioids or barbiturates increase the likelihood that episodic migraine will progress to chronic migraine. Other pain medications such as NSAIDS and triptans appear to carry less risk with frequent use. 

People living with chronic migraine tend to have higher rates of certain comorbidities such as sleep disorders, anxiety, depression, cardiovascular disorders and other chronic pain conditions. All of these comorbidities have been found to increase the risk of transforming from episodic to chronic migraine. Another factor is having cutaneous allodynia, in which someone feels pain from sensations on the skin (particularly over the head and neck) that would not typically feel painful.

About a quarter of people with chronic migraine revert back to episodic migraine or go into complete remission. This may happen spontaneously or as the result of effective treatment.

The American Headache Society recommends considering preventive therapy for people who experience 4 or more migraine attacks per month or use abortive treatments more than twice a week. People may need to try several preventive treatments before finding the best regimen. This may play an important role in preventing episodic migraine from escalating to chronic. 

Effective preventive and acute treatments, especially newer migraine-specific treatments along with modifying risk factors may help people with chronic migraine revert back to episodic migraine or achieve full remission.

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This video is sponsored in part by Amgen.


1. ICHD-3 definition

2. The puzzle of migraine chronification, Nature. 14 October 2020

3. American Headache Society fact sheet 2020



*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.