Chronic Migraine: Signs, Risk Factors and Treatment
Chronic migraine means you have a headache on at least half the days of the month. It is common, it can be very disabling, and there are treatments made for it.
What is chronic migraine?
Headache experts describe three states: no migraine, episodic migraine and chronic migraine. Episodic migraine means 14 or fewer headache days a month. Chronic migraine is diagnosed when you have headaches on 15 or more days a month for more than three months, and at least 8 of those days have migraine features.
Not every headache day has to be a full attack. A day with a mild, low-level headache still counts as a headache day. This is why many people undercount: they remember the bad days and forget the milder ones.
Some researchers question the 15-day line. An AMF-supported study found that people with 8 to 14 headache days a month were about as disabled as people with 15 to 23 days. People with 24 or more days had the highest disability. In other words, you do not need to reach 15 days for migraine to seriously affect your life.
Common symptoms
On migraine days, the features doctors look for include:
- Moderate to severe pain, on one side, both sides or moving around
- Throbbing or pulsing pain
- Pain that gets worse with physical activity
- Nausea, vomiting, or sensitivity to light and sound
Even when pain is nearly constant, symptoms often rise and fall. Learning the signs that a bigger attack is coming can help you time your acute treatment.
How migraine becomes chronic
Migraine attacks can become more frequent over time. The risk of chronic migraine goes up once someone has 4 or more migraine days a month. The AMF lists these risk factors, many of which can be treated:
- Things you may be able to change: acute medication overuse, caffeine, obesity, smoking, sleep problems and snoring
- Health conditions: depression, anxiety, other pain conditions, asthma, and frequent ongoing nausea
- Life events: stressful life events, head or neck injury and difficult childhood experiences
- Other factors: being female, and not having an acute treatment that works for you
Medication overuse headache deserves special mention. Using acute pain medicine too often can make headaches more frequent. The AMF suggests limiting rescue medicine to no more than 10 days a month, with your doctor’s guidance.
How it is diagnosed
Diagnosis is based on counting headache days, not on how disabled you feel. A headache journal is one of the most useful tools you can bring to your appointment. Your doctor will also check that the headaches are not caused by another condition, and will consider other daily headache types, such as chronic tension-type headache, hemicrania continua and new daily persistent headache.
Treatment options
Treatment for chronic migraine looks a lot like treatment for episodic migraine, with a few key differences. A plan often combines acute medicine, preventive treatment, non-drug approaches and work on risk factors.
- Acute medicine: taken at the start of an attack. Examples the AMF names include ibuprofen, acetaminophen and sumatriptan. Use should be limited to avoid medication overuse headache.
- Botox (onabotulinumtoxinA): approved by the FDA in 2010 as a preventive treatment for chronic migraine. It is given as 31 small injections around the forehead, temples, back of the head, neck and shoulders, usually every 12 weeks. In clinical trials, headache days dropped by about half on average. Some people notice a change within days, while others need two or three rounds to see benefit. The most common side effects are neck pain and stiffness. Learn more on our Botox for migraine page.
- Anti-CGRP treatments: approved in 2018 for both chronic and episodic migraine. Evidence suggests they may cut migraine days by six to eight a month in people with chronic migraine.
- Other preventive medicines: some anti-seizure medicines, antidepressants and blood pressure medicines used for episodic migraine may also help.
- Non-drug options: biofeedback, cognitive behavioral therapy and acupuncture, plus steady sleep and good hydration.
- Treating risk factors: addressing depression, anxiety, snoring and weight may also help.
Preventive treatment can take 2 to 3 months to show its full effect, so patience and good records help you and your doctor judge what is working.
What patients say
5.0 from 21 Google reviews
★★★★★
I have watched for years as my wife suffered with chronic migraines. We have seen several doctors and tried countless treatments ranging from traditional medicines, homeopathic options, nutrition and supplements all to no avail. After feeling like there would be no remedy for her, Dr. Park was the first to present a treatment plan that actually worked. She adjusted as we went and has worked with us to ensure relief. She's stopped the years of pain for my wife and feeling helpless from a husband's standpoint, for that I am and will forever be grateful to the kind and thorough doctor that Dr. Park is. She humanizes healthcare in a way that I have never experienced before first hand.
Reviews are shared from Google in the patients’ own words. Individual experiences vary.
How Dr. Park can help
Dr. Hannah Park is a dual board-certified, fellowship-trained headache medicine neurologist with over 10 years of specialized experience, and a lifelong migraine sufferer herself. Your first visit is a 90-minute consultation with Dr. Park: a full history review, a neurological exam, a diagnosis and a personalized plan.
The practice focuses on targeted injection treatments rather than a cycle of prescription medicines, and does not prescribe opioids. In-office options include Botox injections, an occipital nerve block and an SPG block (no needles). If appropriate, an injection can be done at your first visit for an added fee. See services and fees. The practice is direct pay, with no referral needed.
When to get emergency care
Call 911 or go to the nearest emergency room if you have a severe headache that peaks within about a minute for the first time; new, sudden weakness on one side of the face or body, numbness, trouble speaking, vision changes, unusual dizziness or trouble walking; or a high fever or stiff neck with headache.
Related
Sources
This page summarizes patient information from these organizations, in our own words. It is general education, not medical advice.
- What Is Chronic Migraine?, American Migraine Foundation
- How Should We Define Chronic Migraine?, American Migraine Foundation
- The Migraine Path: Risk Factors for Progression of Migraine Disease, American Migraine Foundation
- Frequently Asked Questions about OnabotulinumtoxinA (Botox) for Migraine, American Migraine Foundation
- Common Types of Migraine and Related Symptoms, American Migraine Foundation
- Webinar Recap: The Phases of Migraine, American Migraine Foundation
- Migraine Prevention 101: What It Is, When To Use It and Why, American Migraine Foundation
- Migraine in the Emergency Department: When to Go to the ED for Migraine, American Migraine Foundation
Last updated October 27, 2026.
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