Chronic Migraine Treatment: Latest Advances for Lasting Relief

What is chronic migraine?

Most people have “episodic” migraines, which means they have migraine attacks once in a while. But up to 5% of people with migraines have chronic migraines. People with chronic migraines have:

• Headaches on at least 15 days each month

• Migraine features during some, but necessarily all, of these headaches

These symptoms must last for at least 3 months in order for people to be diagnosed with chronic migraines. 

Chronic migraine symptoms

Chronic migraine symptoms include both migraine headaches and nonmigraine headaches. Migraine attacks can include the following symptoms:

• Moderate to severe head pain

• Intense pain

• Throbbing, pounding, or pulsating head pain

• Head pain that gets worse with movement

• Nausea or vomiting along with head pain

• Sensitivity to light or sound along with head pain

As noted above, people with chronic migraines have at least 15 headache days each month. But they won’t necessarily have migraines on all their headache days. At least 8 of the headache days must be migraine attacks. The other headache days may involve other types of headaches. These headaches can cause mild to moderate head pain and don’t have to have aura or other migraine features. 

Chronic migraine treatment options

Chronic migraine treatment involves a combination of:

• Avoiding triggers

• Migraine prevention

• Real-time pain relief

Using all three techniques can help people have more headache-free days. Treatment can also help migraines feel less intense when they do break through and may reduce the need for medication. Let’s take a closer look at each option. 

Avoiding triggers to treat chronic migraine

The first step in managing chronic migraines is avoiding triggers. Without this step, even the best medications may not be enough to prevent migraines. 

Most people can easily pinpoint their migraine triggers. These are things like foods, light, sounds, or even smells that usually bring on a migraine. If you know your triggers, it’s important to avoid them as much as possible. If you don’t know your triggers, try keeping a headache diary. 

When you feel a migraine starting, write down the date, time, and your symptoms. Also note what you were doing when the migraine started. Over time, you may notice patterns, like your episodes happen more at a specific time of day or in certain locations. This can help you pinpoint your triggers.

Triggers vary from person to person. But there are some things that are more likely to trigger a migraine. These include:

• Not getting enough sleep 

• Skipping meals

• Not drinking enough water (dehydration)

• Stress

• Drinking too much caffeine

As part of your treatment plan, you may need to make some changes in some of these areas. 

Migraine prevention (prophylaxis) medications

Migraine prophylaxis refers to medications that you take regularly to stop migraines from starting. These medications can give you more pain-free days. And they can help you avoid taking too much pain-relieving medication. Too much pain medication can actually make migraines worse. The right migraine prophylaxis can cut the number of monthly headache days by half. 

Finding the right migraine prevention medication can take time. Not everyone responds to these medications in the same way. If your first treatment option doesn’t work, don’t get discouraged. There are several first- and second-line treatment options available. And remember to give the medication time to work. It can take up to 8 weeks to really feel the effects of these treatments.

Below are some of the most common medications used for chronic migraine prophylaxis.

Headache relief (abortive treatments) for chronic migraine

Even if you carefully avoid triggers and find the right prevention medications, migraine breakthroughs are bound to happen. That’s why there’s a part of treatment that focuses on real-time pain relief. These are sometimes called “abortive” treatments. The hope is that, with the right treatment and trigger avoidance, you won’t need to rely on these pain relievers as often. 

Natural and alternative therapies for chronic migraines

Some people prefer to limit how much medication they take. If that’s the case, you may consider adding natural remedies or alternative therapies to your treatment for chronic migraine. 

While there isn’t always a lot of research to support these options, some people find them helpful. Popular options include:

• Vitamins and supplements like magnesium, riboflavin, and coenzyme Q10

• Essential oils

• Acupuncture

• Biofeedback

• Mindfulness-based therapies

Remember, you can add these treatments to your care plan, but be sure to talk with your healthcare team about them first. This helps prevent medication interactions and other unwanted side effects. 

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Written by:

Brian Clista, MD

Dr. Clista is a board-certified pediatrician who works in private practice in Pittsburgh, Pennsylvania. He previously served as a National Health Service Corporation Scholar in the inner city of Pittsburgh for 11 years.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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