Chapter 1, Episode 1: What is Episodic and Chronic Migraine?

This content has been medically reviewed by Dr. Rashmi Halker-Singh.

Migraine is a complex neurological disease that can impact the entire nervous system. The diagnostic criteria for migraine is the following: patients must have had at least five headache attacks that lasted 4 to 72 hours and the headache should have had at least two of the following characteristics: one-sided head pain, pulsating sensation, moderate or severe pain intensity, aggravation by physical activity. In addition, during the headaches the patient must have had nausea and or vomiting, or light and sound sensitivity. Many other symptoms can also be associated with migraine attacks such as confused thinking, ear pain, dizziness and more. It is important to note these are the strict criteria but variations are possible. Therefore you should talk to your doctor for a correct diagnosis based on your history. 

People with migraine can have an episodic or chronic form of the disease. Let’s explore the differences. 

Most people start with episodic migraine which is less than 15 headache days per month. People with chronic migraine have at least 15 headache days per month with light and sound sensitivity, nausea or vomiting for at least eight of those days. 

Between four and six million Americans live with chronic migraine. Why does the difference matter?  The frequency of attacks is important to help determine appropriate treatments and understand how disabling the disease is for a person. Chronic migraine usually represents a more severe form of the disease. 

People with chronic migraine have a disease that has become more difficult to treat, are at risk of excessive use of pain relievers and at risk for medication adaptation headaches, should be considered a candidate for preventative drugs. 

About two to three percent of patients with episodic migraine develop chronic migraine every year. Reasons for this include lack of proper treatment and changes in triggers such as hormones or lifestyle changes.  

Can you treat migraine? Yes. Medications that can be taken on the onset of an attack include over-the-counter options like acetaminophen, ibuprofen or non-steroidal medications in combination with caffeine, or prescription options like triptans, ditans and gepants. Avoid using these medications more than one to two days per week on a consistent basis as they can put you at risk for medication resistance and contribute to migraine chronification. 

Neuromodulation devices can be used as an additional therapy or used in the replacement of pharmaceuticals. 

If you are using abortive treatments more than nine times per month you and your doctor should consider a preventative treatment. Some treatments can be used to prevent attacks including onabotulinumtoxinA,  blood pressure medications, anti-seizure medications, antidepressants and more. Recently CGRP monoclonal antibodies and some gepants have been approved for the preventative treatment of migraine. 

This video is sponsored in part by Amgen, Abbvie, Lilly, Lundbeck, Biohaven, and Impel Pharmaceuticals.

*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.