Chronic migraine refers to a patient that has headaches at least 50% of the days. Not all headaches have to be "migraine" but at least 8 headaches per month should meet criteria for migraine. Patients who have headaches at least 50% of the days but less than 8 migraine days are called chronic daily headache. As long as some headache days meet criteria for migraine, there patients are treated as is they have chronic migraine headaches. Most patients who have chronic migraine have a history of intermittent migraine that then increase in frequency. For most patients, a cause for the increased frequency is not found but a cause should be looked for in all cases. This is commonly done with blood work but imaging of the head with MRI or CT is very common as well. Some patients with chronic migraine take medications that can cause rebound headache. This is a condition when the medication being used to treat the migraines actually causes more headaches. Determining if someone has rebound headache can be very difficult.
The key to treating chronic migraine is to start a patient on prevention. It is generally a good idea to limit acute medication use and change medications that may be causing rebound headache at the same time. Although only Botox® is approved for the treatment of chronic migraine with or without rebound headache, it is common to use any of the preventatives for frequent migraine for chronic migraine. Combination preventative therapy is common although their is little proof to its benefit.
Because chronic migraine patients will have to manage this disease for years and the treatment can be quite complex, keeping an excellent headache diary using a tool like iHeadache is essential.
This educational content was written by Brian D. Loftus, MD, a neurologist, headache specialist and developer of iHeadache. The science and study of headaces is changing rapidly. If there is information on this page that is incorrect or needs revision, please contact us.
iHeadache is a comprehensive electronic headache diary that tracks how many headaches you are having, your disability, medication usage, triggers, pain and more.
Originally developed for the iPhone and BlackBerry, iHeadache is now available online. Your data is available, at a glance or in detail, when you need it.
Share your data with your doctor to optimize your treatment plan. Accurate headache tracking helps you and your doctor determine what works and what doesn't.