Migraines are a common and disabling condition affecting over 1 billion people worldwide. The World Health Organization identifies migraines as one of the top ten causes of disability. Some people get them occasionally, while others experience them often, greatly affecting daily life.
About 12% of people worldwide have migraines. Most suffer from episodic migraines (about 90%), while chronic migraines affect 3-5% of adults, with headaches on 15 or more days a month. Chronic migraines can seriously impact work, social life, and mental health.
Knowing the difference between episodic and chronic migraine helps you get the right treatment. Find out how they differ, common triggers, and how to manage them.
What Are Episodic and Chronic Migraines?
Episodic migraine refers to migraines that occur less frequently. If you experience headaches fewer than 15 days per month, you likely have episodic migraines. Chronic migraine, on the other hand, is described as headaches on 15 or more days per month for at least three months, with migraine symptoms present on at least eight of those days.
Dr. David Kudrow points out that the 15-day cutoff is somewhat arbitrary since people with 8 to 14 migraine days a month can experience a similar level of disability as those with 15 or more. Nonetheless, the 15-day period is utilized to diagnose.
Symptoms of Episodic and Chronic Migraine
The symptoms of both episodic and chronic migraines are similar, but the frequency and severity set them apart.
Episodic Migraine Symptoms:
- Moderate to severe head pain, often on one side
- Sensitivity to light and sound
- Nausea and vomiting
- Blurred vision or aura
These migraines can last from a few hours to a couple of days, but because they occur less often, they may have less impact on daily life.
Chronic Migraine Symptoms:
Chronic migraines have similar symptoms to episodic migraines, but they occur more frequently. Additionally, chronic migraine sufferers may experience:
- Continuous, daily headache pain
- Increased risk of anxiety and depression
- Difficulty maintaining work and social commitments
Since chronic migraines are almost a daily occurrence, they can lead to physical and emotional exhaustion.
Common Triggers for Episodic and Chronic Migraines
Migraine management requires the identification of triggers. While the triggers for episodic and chronic migraines are often similar, chronic migraine sufferers may become more sensitive over time.
Common triggers include:
- Emotional and physical stress are major triggers for migraines.
- Hormonal changes, particularly during menstruation, pregnancy, or menopause, can trigger migraines in women.
- Certain foods and drinks, like alcohol, caffeine, processed foods, and artificial sweeteners, may provoke migraines.
- Another typical trigger is a lack of sleep or inconsistent sleeping patterns.
- Bright lights, loud noises, and strong smells can exacerbate migraine symptoms.
In episodic migraine, these triggers may cause an occasional attack. For those with chronic migraine, constant exposure to multiple triggers can lead to daily or near-daily headaches.
Risk Factors and Causes
Both episodic and chronic migraines share similar risk factors, but some are more closely associated with the transition from episodic to chronic migraine.
Risk factors include:
- A family history of migraines raises your risk.
- Women are three times as likely as males to get migraines.
- Migraines typically begin during adolescence and are most common in your 30s.
- Frequent use of painkillers can turn episodic headaches into chronic migraines.
Medication overuse is a significant factor in developing chronic migraines. If you take over-the-counter pain medicines for more than ten days each month, you may be at risk.
Diagnosis of Episodic and Chronic Migraine
Diagnosing the type of migraine you have is the first step toward effective treatment. A healthcare professional will review your medical history, symptoms, and headache frequency. You may be asked to keep a headache diary to track your attacks, triggers, and symptoms.
Diagnostic criteria:
- Episodic migraine: Fewer than 15 headache days per month.
- Chronic migraine: 15 or more headache days per month, with migraine symptoms on at least 8 days.
Can Episodic Migraines Turn Into Chronic Migraines?
Yes, about 3% of people with episodic migraines develop chronic migraines each year, according to a 2021 review. With treatment, it’s more common for chronic migraines to improve and become episodic again. When symptoms improve, this is called remission.
Treatment Options
The treatment for episodic and chronic migraine differs in approach and intensity. While both types benefit from lifestyle changes and preventive strategies, chronic migraines often require more aggressive treatment.
Episodic Migraine Treatment
- Over-the-counter pain medicines including ibuprofen, acetaminophen, and aspirin can provide temporary relief.
- Prescription medications like triptans are commonly used for acute migraine attacks.
- Lifestyle changes, including regular sleep, a healthy diet, and exercise, can help reduce migraine frequency.
- Meditation, yoga, and relaxation exercises are all helpful stress-management approaches.
Chronic Migraine Treatment
For chronic migraines, a combination of preventive and acute treatments is typically required.
- Preventive medications, such as beta-blockers, antidepressants, and seizure medications, can help reduce migraine frequency.
- Botox injections are FDA-approved for chronic migraines and can help reduce the number of headache days.
- CGRP inhibitors are newer drugs that block the calcitonin gene-related peptide, which causes migraines.
- Physical therapy is beneficial for those with neck pain or tension headaches linked to migraines.
- Counseling and mental health support can help manage anxiety or depression that often accompanies chronic migraines.
Managing and Preventing Migraines
Prevention is crucial for both episodic and chronic migraine sufferers. While episodic migraine management may focus on avoiding triggers, chronic migraine prevention often involves a more structured, long-term plan.
Tips for migraine prevention:
- Identify and avoid triggers by keeping a headache diary to recognize patterns.
- Maintain a consistent sleep pattern and prioritize quality sleep.
- Stay hydrated; dehydration is a major migraine cause.
- Eat well-balanced meals, avoid missing meals, and limit processed foods.
- Exercise regularly, as moderate physical activity can help reduce migraine frequency.
For chronic migraines, sticking to a comprehensive prevention plan can make a significant difference.
When to See a Doctor
If you experience frequent headaches or your migraines worsen over time, it’s essential to seek medical advice. A doctor can help you decide whether you have episodic or chronic migraines and prescribe treatment options.
Seek immediate medical attention if you experience:
- Sudden, severe headaches
- Headaches accompanied by confusion, speech difficulty, or weakness
- Headache after a head injury
Taking Control of Episodic and Chronic Migraines
Migraines, whether episodic or chronic, are deeply personal experiences that can affect every aspect of life—work, relationships, and mental health. What’s crucial is recognizing that migraines aren’t just something you have to endure.
With early diagnosis, identifying triggers, and finding the right treatment plan, you can prevent episodic migraines from escalating and even reclaim control if you’re already dealing with chronic ones. Every small step in managing your migraines adds up to long-term relief and a better quality of life.