Chronic migraine

Key signs and symptoms

Migraine pain is often moderate to severe, sometimes one-sided and throbbing, and may worsen with normal movement. Nausea, vomiting and sensitivity to light and noise are possible. Some people experience an aura – transient visual, sensory or speech symptoms. Not every migraine involves an aura, and not every visual disturbance should be taken as such. NHS on migraine

In the chronic form, symptoms can vary from day to day. It is therefore useful to record even mild headaches, not just the attacks that force you to lie down. Note how the pain affects your daily activities: time off work, the need for rest or an inability to engage in physical activity. This provides a more complete picture of the severity than a rating on a scale of one to ten alone.

Types and important distinctions

Episodic and chronic migraine are distinguished primarily by the frequency of the headaches. The presence or absence of an aura is a separate characteristic. The term ‘chronic’ does not necessarily mean continuous pain every minute, nor does it mean that improvement is impossible. With successful treatment, the number of days affected may decrease and the condition may revert to an episodic pattern.

The duration of the condition alone does not define the chronic form. A person may have suffered from migraine for many years, but with only rare attacks. Conversely, frequent headaches over a period of several months require assessment, even if there is no long history. Other types of headache can also be frequent and should not automatically be labelled as migraine.

Why it occurs and what contributes to it becoming chronic

Migraine is a neurological condition with a complex mechanism. Genetic predisposition plays a role, and attacks can be influenced by changes in sleep patterns, stress, skipping meals and hormonal fluctuations. The same factor does not affect everyone in the same way. It is incorrect to explain the condition solely in terms of ‘tense muscles’ or a lack of willpower to cope with stress.

For some people, episodic migraine gradually becomes more frequent. Sleep problems and the excessive use of medication for the attacks can complicate the picture. That is why the doctor discusses not only the severity of the pain, but also how many days a month medication is taken. Chronic migraine can co-exist with medication-overuse headaches; this requires a comprehensive treatment plan. Clinical guidelines for migraine prevention

When to see a doctor

Book an appointment if you experience frequent headaches, an increasing need for painkillers, or attacks that interfere with your daily life. New or significantly changed pain requires a reassessment, even if you have already been diagnosed with migraine. During pregnancy, after childbirth or in the case of other medical conditions, the choice of treatment and the urgency of the consultation are assessed on a case-by-case basis.

A sudden, extremely severe headache, new-onset weakness, confusion, slurred speech, loss of vision, a seizure, or a headache accompanied by a high temperature and a stiff neck require immediate emergency assistance by dialling 112. Do not dismiss these new symptoms as ‘my usual migraine’. It is particularly important not to delay seeking help if symptoms appear for the first time or if they are markedly different in nature.

How is the diagnosis made?

The neurologist assesses the type and frequency of the headaches, accompanying symptoms, medication and the results of the examination. Imaging tests are ordered where specifically indicated. Simply wanting injection treatment is no substitute for a diagnostic assessment. For your consultation, bring details of previous treatments, their duration, effectiveness and the reasons for stopping them.

A headache diary is a practical tool. Record the days you have a headache, its severity, migraine symptoms and the medicines taken. Note down important circumstances, such as lack of sleep or menstruation, without necessarily looking for a cause for every attack. A short, regularly updated diary is more useful than a complex table that you’ll abandon after a few days. Migraine monitoring and daily care

Daily care and home remedies

A regular sleep pattern, eating without long gaps between meals, adequate fluid intake and gradual physical activity can help with management. There is no need to cut out a long list of foods that have no personal link to the attacks. Change your habits gradually to find out what works for you. Adhering to a routine complements treatment, but it does not mean the patient is to blame if the attacks continue. Guidelines for daily habits

During an attack, a quiet, darkened room and a comfortable cool compress may provide relief. These are not a preventative treatment for chronic migraine. Popular remedies involving essential oils, herbs or high doses of supplements should not replace prescribed treatment. Even over-the-counter products can have side effects and interactions.

If you wish to try a supplement, discuss the specific product and its intended use. Do not increase your intake of painkillers on your own if the pain becomes more frequent. Agree a plan with your doctor for managing attacks and limits on medication use. If overuse is suspected, treatment adjustments will be made depending on the type of medication and your overall condition.

Modern treatment methods

Treatment involves managing individual attacks and prevention. Appropriate painkillers, specific anti-migraine medicines and anti-nausea medication can be used to treat an attack. Prevention aims to reduce the number and severity of headache days. The choice of treatment takes into account previous response, accompanying conditions, possible pregnancy and individual tolerance.

Preventative options include certain traditional medicines, therapies targeting CGRP – a molecule involved in migraine mechanisms – and botulinum toxin type A in suitable patients. Availability and prescribing conditions depend on the specific therapy and local practice. International guidelines serve as a guide for clinical assessment, rather than an automatic guarantee of access or reimbursement. NICE – guidelines for the treatment of headaches

The role of botulinum toxin

For chronic migraine, a specialised protocol is used involving injections into specific muscles of the head and neck, usually at intervals of around 12 weeks. This is a preventative treatment, not a means of immediately stopping an attack. The regimen differs from aesthetic treatment of the forehead and cannot be replaced by it. Product information for BOTOX

The effect is monitored via a diary and functional improvement, sometimes after more than one course of treatment. Possible side effects include pain at the injection site, pain or weakness in the neck, and temporary drooping of the eyelid. If there is insufficient benefit, the treatment plan is reviewed. Information on treatment follow-up

If you are considering injection therapy and seeking information from Skin Line, please have your neurological diagnosis and treatment history to hand. The first step is to determine the appropriate clinical pathway. The decision must be aligned with the overall migraine management plan and involve follow-up by a specialist with experience in this condition.