When Is Migraine Classified As Chronic?

Contrary to popular belief, migraine isn’t just a bad headache. It’s a neurological disorder that directly affects the brain and how it functions, with symptoms severe enough that you become unable to perform your daily activities.

According to the Migraine Research Foundation (MRF), migraine is the third most prevalent and sixth most disabling disease in the world. 

There are many misconceptions about migraine, which is why at Primecare Family Practice in Arlington, Texas, board-certified family practitioners Maryline Ongangi, APRN, FNP-C, and Lewis Nyantika, APRN, FNP-C, try to educate their patients about headaches and migraine.

One issue that many people find confusing, and that affects migraine treatment, is when the disease is considered episodic and when it’s classified as chronic. Here, the team explains the difference and discusses how we can help you manage your migraine attacks so you can return to your normal life.

What is a migraine attack?

A migraine attack is when you experience the symptoms of migraine. It’s generally divided into four categories, although not everybody experiences all four or in the same order.

1. Prodrome

The prodrome, or promontory phase, starts two to three days before the pain hits, and it’s categorized by a number of neurological symptoms, including sensitivities to light, sound, touch, and smell; excessive yawning; food cravings; irritability; and generally feeling unwell.

2. Aura

People either have migraine with aura or without aura. If you have it with aura, you experience neurological symptoms starting 10 minutes to one hour before the pain hits, including flashing lights or zigzag lines across your vision, speech disturbances, tinnitus, diarrhea or constipation, and weakness or a tingling sensation in your limbs. 

Only about 30% of migraine patients experience an aura.

3. Pain

This is what most people think of when they hear the term “migraine.” The pain is generally one-sided, throbbing, of moderate-to-severe intensity, and cannot be relieved with over-the-counter medications.

This phase also includes neurological symptoms, such as nausea and vomiting, as well as sensitivities to light, sound, smell, and touch.

The pain lasts anywhere from 4 to 72 hours.

4. Postdrome

Just because the pain eases up doesn’t mean you’re through with the attack. Postdrome is like a post-adrenaline crash. You feel sluggish, wiped out, have difficulty concentrating (“brain fog”), and you may have the remnants of the pain. This phase lasts a day or two.

When is migraine classified as chronic?

Chronic migraine attacks consist of the same symptoms as episodic attacks, but they occur more frequently and/or last longer. In fact, some people are always in some phase of a migraine attack. And while it’s possible to have an episodic attack without the pain phase, chronic attacks always include headaches.

To receive a diagnosis of chronic migraine, you must have:

1. Fifteen or more headache days per month for at least three months, and
2. At least eight days per month, when your headaches include neurological symptoms

For migraine without aura, the pain phase must meet at least two of the following:

• Pain on one side of your head
• Pain with a pulsing or pounding feel
• Pain that’s moderate or severe
• Pain that worsens with even basic levels of activity or makes you avoid activity

In addition, the pain must be accompanied by nausea, vomiting, or sensitivity to light (photophobia) or sound (phonophobia).

Treatments exist for chronic migraine that aim to decrease the frequency and severity of attacks. The latest class of drugs to help prevent migraine attacks (now considered the gold standard) are those that target calcitonin gene-related peptide (CGRP), a protein known to be involved in migraine and triggering attacks.

There are also medications and neuromodulators that abort an attack once it’s gotten started. The triptans are an older class of drug used off-label for migraine, and the gepants, like the CGRP treatments, are new, migraine-specific medications.

If you’re struggling with the pain and other symptoms of frequent migraine attacks, either episodic or chronic, Primecare Family Practice can help. Call the office at 817-873-3710 to schedule, or book online with us today.