If you have frequent migraine attacks, you know what it's like to experience throbbing head pain alongside nausea and vomiting, as well as a heightened sensitivity to light and sound. You may also experience auras — bright flashes of light, pin and needle sensations, or weakness in part of your body.
Your health care provider can help you understand these symptoms and determine if your condition is considered chronic or episodic. While both kinds of migraine can have similar symptoms, there are some important differences to understand. Here’s what you need to know about chronic and episodic migraine so you can get proper treatment and maintain your quality of life.
The main difference between chronic and episodic migraine is how frequently a person experiences migraine attacks. People with episodic migraine experience 14 or fewer headache days per month, whereas those with chronic migraine experience 15 or more headache days per month for at least three months.
To be diagnosed with chronic migraine, you also need to experience at least one of the following symptoms for at least eight days of the month:
Note that episodic migraine can have these features, too, as they are generally considered migraine symptoms. However, in people with episodic migraine, headaches will go away between migraine attacks. People with chronic migraine may still experience less severe headaches in between migraine attacks.
It’s possible to have episodic migraine that turns into chronic migraine and vice versa. Just because you have chronic migraine at one point in your life does not mean that you will always experience migraine attacks that meet the criteria for that diagnosis.
Researchers are not sure how frequently these transitions happen. A report in the journal Current Pain and Headache Reports (CPHR) noted that 2.5 percent of people with episodic migraine transitioned to chronic migraine over one year, and 26 percent of people with chronic migraine transitioned to having episodic migraine over two years.
A different research study in The Journal of Headache and Pain showed that the fluctuations between episodic and chronic migraine can be complex. In the study, some people qualified for a diagnosis of chronic migraine most of the time, but they still had months where they dipped below the 15 headache-days-per-month threshold.
The relationship between chronic and episodic migraine is complicated, but what you need to know is that you can move between these categories. Some MyMigraineTeam members have experienced this, like one who said, “I have chronic migraines. They have gotten worse as I age.” Another added, “At 50, I went from episodic to chronic.”
Only 7.7 percent of people who experience migraine attacks have chronic migraine, according to the CPHR report. The rest have episodic migraine or other types of migraine. This is true in both women and men. Per CPHR, a United States-based study showed that 17.1 percent of women experienced episodic migraine every year, while only 1.3 percent experienced chronic migraine. For men, the numbers were 5.6 percent with episodic and 0.5 percent with chronic migraine.
Not only do people with chronic migraine experience more migraine days per month, but their symptoms tend to be more severe, too. In people with chronic migraine, every migraine attack tends to last longer than they do in people with episodic migraine. This remains true whether or not someone uses acute or preventive migraine treatments.
Chronic migraine also tends to come with more severe pain than episodic migraine, making them worse in that aspect as well.
People living with chronic migraine are more likely to experience some other medical conditions than people with episodic migraine. They may have more pain in general, outside of their headache pain. They may also experience more vascular (blood vessel) problems, as well as more psychiatric diagnoses, like depression and anxiety. Heart and lung problems, like high cholesterol and asthma, are also more common in people with chronic migraine than in those with episodic migraine.
It’s important to note that these research findings are correlations, so researchers are not certain if chronic migraine causes vascular problems, for example, or if vascular problems might cause chronic migraine. If you have chronic migraine, it’s important to be aware of the fact that you are at an increased risk of certain health conditions. With this information, you can work with your health care provider to address those risk factors and potential comorbidities.
Chronic and episodic migraine have similar treatment options. However, people with chronic migraine may not respond to some medications as well as people with episodic migraine.
When it comes to acute treatment, people with both types of migraine need to take medication as soon as possible after the onset of a migraine attack. People with chronic migraine may not respond as well to some acute medications, specifically triptans.
People with chronic migraine may also be more likely to get headaches (called medication overuse headaches) from overusing painkillers. This can worsen a migraine attack or cause more frequent headaches.
Preventive migraine treatment options may also be less effective in people with chronic migraine. One study noted that, of all the medications available for the treatment of chronic migraine, only one — topiramate (Topamax) — had clinical studies showing that it was effective for chronic migraine.
A newer type of migraine treatment called calcitonin gene-related peptide (CGRP) monoclonal antibodies (also called CGRP antagonists) may be effective for people with chronic migraine who haven’t had success with other types of treatment. A 2023 study conducted in Spain found that these treatments were safe and effective for people over 65 with both chronic and episodic migraine. Current CGRP antagonists include erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab (Vyepti).
If you feel like your current migraine medication isn’t working well enough, or if the side effects are unmanageable, talk to your neurologist or neurology team to find out what might be the better treatment plan for you.
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