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HeadWay, Issue #109 -- How Frequent Are Your Headaches?
July 19, 2013

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In this issue:

Frequent Migraine and Chronic Migraine

Say what?! Chronic Migraine

Frequent Migraine and Chronic Migraine

How many migraine attacks do you have in a year?  A month?  Do you have more than one a week?

How you answer those questions makes a huge difference in how you need to look for good treatment.

A recent article at the New York Headache Blog reminded me again how important it is for people to deal with migraine attacks that come - well, often!

But how many attacks do you have before you have "chronic" migraine?  Before you should consider a preventative medication?  Before you should see a specialist?

I don't think the specialist is ever a bad idea, but due to cost and distance and time it can be difficult for some.

Here are some things to think about depending on the frequency of your attacks:

Migraine Day: Every few months

A migraine attack every few months is serious, but probably not a reason to take preventative medication.  Do see a doctor, if possible a specialist, and get to a doctor right away if there are changes in your symptoms.  There are excellent treatments available for you.

Migraine Day: Every month

Of course, if you're a woman, a prime suspect here is menstrual migraine - and there are different types of menstrual migraine depending on when the attack comes in your cycle.  Menstrual migraineurs have an advantage - some great, specific research has been done for menstural migraine.

At this point, menstrual migraine or no, your specialist may recommend some lifestyle changes, some mild supplements, and perhaps medications and other treatments depending on your symptoms.

Be cautious about jumping into preventative medications here - the side effects and risks may not be worth it.  There are other treatments available.

Migraine Days: 2/month to 2/Week

At this point, migraine has an even more serious impact on life, even when you're not having an attack.  Up to this point, your doctor may have recommended an abortive such as a triptan or even ibuprofen.  But once your attacks get more than a couple a month, you need to re-assess.

If your attacks have increased in frequency, see a specialist (at this point you need a specialist if at all possible) and discuss other options.  Taking abortive medication this often without a full treatment plan usually isn't wise, and can be dangerous.  It can also end up making things worse.

Migraine Days: 10-14/month

This is about 2-3 attacks per week.  This is high frequency, though still not technically called "chronic".

In the article I mentioned above, Dr. Mauskop pointed out that the profiles of patients with frequent migraine were similar to those with chronic migraine.  This included some symptoms and conditions that tend to go along with migraine - chronic pain, depression, respiratory conditions, and stroke.

This means that things are getting increasingly serious, and migraine needs to be treated.  You need to take the time to find a specialist who takes your condition seriously and will not give up on you.

At this point you should be seriously looking at preventative treatments, including medications, supplements, lifestyle changes, and other forms of therapy.  We're not looking for a pop-a-pill solution, but a whole-life solution.

Migraine Days: 15 or more a month

Obviously at this point migraine will not be ignored.  Though serious at any frequency, chronic migraine can cause problems that low frequency migraine would never cause.  Increased risk for other conditions, loss of productivity and job, high disability.

There are excellent treatments even for chronic migraine, but you may need to take more time and effort to find a team of health professionals who can help you find the best treatments.  They need to know your medical history, and they need to work together.

You also need to consider that you may have different symptoms that can be treated in different ways.  That is to say, it's easy to say it's all "migraine" when you are in almost constant pain.  But there could be other headache conditions, and other comorbid or even unrelated conditions, that can be causing problems.

It's even more important here to keep track of your symptoms, tell your doctor or specialist of any changes, know your medical history and family medical history, and keep track of the treatments you're using.


Just one migraine attack can be a terrible thing.  But if they start coming more often, you need to pay attention.

If you're getting more attacks than just every few months, keep a diary; and remember to keep track of every symptom you can, not just headache.

One more important note:  Many people, especially with low-frequency migraine, tend to think of migraine as only the "severe" headaches.  Yes, migraine can be mild as well.  If you're having only a few moderate to severe attacks, but very frequent headaches, you may have a more serious condition than you thought.  Start keeping that diary, and find a good doctor or specialist.  It's not normal to have frequent headaches, severe or not.

Yes, there are treatments available no matter where you are on the scale.  But how to find them and how they will work will change depending on how frequent your attacks are.

Say what?! Chronic Migraine

Chronic migraine is usually diagnosed if there are 15 or more days with migraine headache per month over three months or more.  However, before you're diagnosed with chronic migraine you will have tests to rule out other conditions.

The headache has to be thought of as a migraine headache - that is, you will have some of the typical symptoms such as nausea, sensitivity to light or sound, a pulsating pain, or one-sided pain.

Similar to chronic migraine is medication overuse headache, which is a series of migraine types brought on by overuse of various medications.

Obviously, many people have migraine attacks with no headache at all.  Non-headache symptoms must be kept track of in order to get a proper diagnosis.

Thanks for reading!  Remember, if you have feedback or ideas for future issues, visit the HeadWay MailRoom.  Your password is nomoache.
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