How Do You Know If You Have Chronic Migraines?

It is crucial to consult a healthcare physician if you suspect you have chronic migraine. This might be your primary care doctor or a headache expert.

The diagnosis of a chronic migraine depends on the number of days a headache persists rather than the level of disability, so it is vital to keep a track of the number of headache days.

• Sometimes, you may miscalculate your headache days because you tend to consider only the days when you experience bad headaches.
• You must understand that it is equally important to keep a track of days that you consider the headaches to be manageable or not too bad.
• Keep a headache notebook to keep track of all your headache days to avoid this.

If you only report the most severe headaches, you may provide your doctor with an inaccurate picture of your real headache load. As a result, they may overlook the diagnosis of chronic migraine.

If you suspect a chronic migraine, you should be thoroughly evaluated by your doctor to rule out other possible reasons for recurrent headaches. Secondary headaches, for example, might be caused by an underlying ailment or disease, as well as other types of chronic daily headaches. You might have a chronic tension-type headache, hemicrania continua, or a new everyday chronic headache.

Your doctor may diagnose you with a chronic migraine by considering all your signs and symptoms. However, sometimes due to inaccuracy of the information provided by you, the doctor may require additional tests to confirm the diagnosis.

Your doctor may order blood tests or imaging tests, such as magnetic resonance imaging or computed tomography scan of the brain. These tests can rule out any other possible reasons for the headache. These tests and your headache journal can assist your doctor in determining what is causing your migraines.

The specific cause of migraines is unknown; however, they are assumed to be caused by abnormal brain activity that momentarily disrupts nerve impulses, neurotransmitters, and blood vessels in the brain.

It is unclear what causes this shift in brain activity, but it's conceivable that your genes predispose you to migraines in response to a specific trigger.

There are several probable migraine triggers, including hormonal, emotional, physical, nutritional, environmental, and pharmaceutical aspects.

These triggers are quite personal. However, keeping a record may help you find a regular trigger. It can sometimes be difficult to determine whether anything is a true trigger or whether what you're feeling is an early sign of a migraine attack.

1. Hormonal changes:
   • Some women get migraines around the time of their menstruation, probably due to changes in hormone levels such as estrogen. These headaches often occur between two days before and three days following the onset of your menstruation.
   • Some women exclusively get headaches during their period, which is known as a pure menstrual migraine. However, most women get them at other times as well, which is known as a menstrual-related migraine.
   • Many women find that their headaches improve after menopause, whereas menopause can induce or worsen migraines in other women.
2. Emotional triggers:
   • Stress
   • Anxiety
   • Excitement
   • Tension
   • Depression
   • Shock
3. Physical triggers:
   • Lack of proper sleep
   • Tiredness
   • Poor posture
   • The shift in work timings
   • Jet lag
   • Excessive exercise
   • Tension in the neck or shoulder
   • Hypoglycemia (low blood sugar)
4. Dietary triggers:
   • Drinks that contain caffeine such as tea and coffee
   • Alcohol
   • Dehydration
   • Chocolates
   • Citrus fruits
   • Irregular meals
   • Cured or packaged meat
5. Environmental triggers:
   • Exposure to bright lights
   • Exposure to strong scents
   • Loud noises
   • Smoking
   • A drastic change in weather

Common symptoms of a chronic migraine include:

1. Headaches that range from mildly bothersome to excruciatingly painful, especially when physical exertion is involved
2. Aching on one or both sides of the head
3. A pounding feeling that causes pressure to be released
4. Photophobia, sound sensitivity, and impaired olfactory sensitivities
5. Feeling of sickness
6. Dizziness

Symptoms of chronic migraine are so similar to those of episodic migraine. The only difference between them is that the frequency of headaches is higher in chronic migraine, ranging from 15 days or more to three months. The dose and frequency of medications are increased for chronic migraines because the discomfort lasts long.

Chronic migraine therapy focuses on controlling lifestyle choices and headache causes, managing migraine attacks, and delivering migraine prevention medications.

1. Lifestyle changes:
   • If you are overweight, it is recommended you lose weight.
   • Start a fitness program that has been recommended by your doctor.
   • Stress is one of the important factors of chronic migraines. You must manage stress by learning stress-reduction strategies such as meditation, yoga, relaxation training, or mindful breathing.
   • Establish a system for meal and snack times; do not skip meals.
   • Staying hydrated is essential.
   • Begin treatment of any preexisting mood condition (including depression and anxiety) or sleep issue.
2. Treatment plan:
   • Treat migraine attacks early while the pain is minimal; start with a basic pain reliever (acetaminophen, aspirin, ibuprofen, and naproxen) and gradually increase the amount to the maximum tolerable dose, unless the headache is severe at the start or will become severe. To boost effectiveness, use the above medicines along with a triptan. It is advisable to avoid opiates. 
   • Treat any accompanying adverse symptoms, such as nausea.
   • Consider other treatments such as transcranial magnetic stimulation and transcutaneous supraorbital nerve stimulation.
3. Preventive treatments:
   • Your doctor may advise you to start on various medications to prevent the headaches:
     • Beta-blockers
     • Tricyclic antidepressants
     • Angiotensin blockers
     • Anticonvulsants
     • Botox injections

Controlling the headache is the hope for people with chronic migraine. It is fair to suppose that with a competent treatment strategy, the quantity and intensity of migraine headaches may be minimized. Many people with chronic migraines may experience migraine attacks again in the future.

There are alternative possibilities for people with persistent migraines who have not responded to earlier therapies. Some people require more intensive hands-on treatment, such as nerve blocks and trigger point injections. Other people, particularly those suffering from drug overuse headaches, require detoxification (the removal of prior medicines) in a controlled facility, such as an infusion suite. People in the infusion suite get intravenous drugs that treat nausea and vomiting, as well as headaches.