Some people assume migraines are “just bad headaches.” But if you or someone you love is living with chronic migraines, you know that’s not the case.

The defining feature of chronic migraine is how often attacks happen. When headaches occur on 15 or more days each month, there is often little time to fully recover before symptoms return. This can make work, relationships, and everyday activities difficult to manage, while also making it harder to identify triggers or know whether your condition is improving.

In this guide, we’ll explain what chronic migraine is, how it’s diagnosed, what symptoms to expect, which treatments are available, and why tracking headache days is such an important part of managing the condition.

Let’s get into it.

Chronic migraine is not “just” headaches

All migraines are headaches, but not all headaches are migraines.

“Headache” is an umbrella term for some sort of pain in the head, and there are different causes and types.

Migraine is a subtype of headache. It’s a neurological condition that causes head pain and a wide range of other symptoms, varying from person to person. Most people with migraine have episodic migraine, meaning attacks occur on fewer than 15 days per month. Chronic migraine is diagnosed when headaches occur on at least 15 days per month, including at least eight days with migraine, for more than three months.

Migraine can significantly affect work, relationships, and everyday activities. For people with chronic migraine, the high frequency of attacks often makes that impact even greater.

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Symptoms of chronic migraine

The symptoms of chronic migraine are the same as those of episodic migraine. The main difference is how often they occur.

People with chronic migraine experience headache symptoms on at least 15 days per month, with migraine symptoms on at least eight of those days.

No two people experience migraines in the same way, but they typically include four primary stages:

Prodrome

Prodrome is the early stage of a migraine. You may start noticing symptoms up to 24 hours before the active headache phase begins, including:

• Food cravings
• Mood changes
• Uncontrollable yawning
• Fluid retention
• Urinating more often than usual

Aura

Aura is a temporary neurological disturbance that some people experience before or during a migraine attack.

Visual symptoms are the most common and may include flashing lights, zigzag lines, blind spots, or shimmering patterns.

Others also experience sensory symptoms, such as tingling or numbness, or less commonly, speech or language difficulties.

Aura does not occur in everyone with migraine, and some people experience aura without developing a headache.

Headache

This is the active phase of a migraine attack where head pain typically occurs. Because people with chronic migraine experience attacks so frequently, symptoms can have a significant impact on work, relationships, and everyday life.

Migraine headaches are commonly described as a sensation of intense throbbing or pulsing on one side of the head.

You may also experience:

• Sensitivity to light, sound, or scents
• Nausea
• Vomiting
• Worsening pain if you cough, sneeze, or move

The headache stage of a migraine can last anywhere from a few hours to multiple days.

Postdrome

Many people feel drained after the headache has passed. For people with chronic migraine, frequent attacks can mean there is little time to fully recover before symptoms return.

The postdrome phase is often described as a “migraine hangover.” It typically lasts for a day and is characterized by fatigue, weakness, and occasionally confusion.

What causes chronic migraine

Migraines are thought to be caused by a combination of genetic, environmental, and neurological factors, but the exact cause of chronic migraine is not yet understood.

This being said, many people with chronic migraine or other migraine disorders have triggers that worsen their symptoms. Some of the most common include:

• Stress
• Hormonal changes, including menstruation, ovulation, and pregnancy
• Missing meals
• Weather changes
• Poor sleep or changes in sleep patterns
• Strong smells
• Neck pain
• Bright lights
• Certain noises, including low- or high-frequency sounds
• Alcohol
• Heat
• Particular foods, including aged cheese, red wine, chocolate, and processed meats
• Caffeine
• Exercise

Diagnosing chronic migraine

There is no blood test or imaging test that can diagnose chronic migraine. Instead, diagnosis is based on assessment by a doctor and reviewing your past symptoms.

Your doctor will assess whether you meet the following criteria over a three-month period:

• Have a headache (migraine or tension-type) for 15 days per month or more
• Have at least eight days per month where your headache involves migraine symptoms

In some cases, you may be referred to a neurologist for assessment.

Before you speak to your medical team about your symptoms, prepare to answer the following questions:

• How many headaches do you have per month?
• What do your headaches feel like?
• Have you ever had a migraine before?
• Have you had any notable changes in your stress levels lately?
• Do certain things make your headaches worse?
• To what extent do your headaches impact your regular daily activities?

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Can episodic migraine become chronic migraine?

Yes. Some people with episodic migraine develop chronic migraine over time. Risk factors include having frequent migraine attacks, medication overuse, obesity, poor sleep, and certain mental health conditions. Early treatment and regular symptom tracking may help identify changes sooner.

Chronic migraine treatment

There is no cure for chronic migraine, but you can do things to help manage it.

Treatment is grouped into two primary categories:

• Preventative, to help reduce the risk of migraine episodes
• Rescue, to help manage symptoms during an active headache

Preventative medications

Preventative medications are a key part of chronic migraine management. They help reduce the frequency and severity of migraine attacks. Common examples include:

Medication

• Tricyclic antidepressants – Amitriptyline (Elavil®), nortriptyline (Pamelor®)
• Angiotensin II receptor blockers – Candesartan (Atacand®)
• Serotonin antagonists – Pizotifen (Sandomigran®)
• Antiseizure medications – Sodium valproate (Epilim®), topiramate (Topamax®)
• Beta blockers – Propranolol (Inderal®)
• Calcium channel blockers – Verapamil (prescribed in the US) and flunarizine (more common across Europe and Canada)
• Monoclonal antibodies (CGRP inhibitors) – Erenumab (Aimovig®)

Botox injections may also be recommended for some people with chronic migraine, particularly when migraines occur very frequently or have not responded well to other preventative treatments.

Lifestyle changes that help prevent migraines

Lifestyle changes can help reduce the frequency of migraines in some people.

The American Migraine Foundation recommends following their helpful mnemonic SEEDS:

• Sleep: Sticking to a consistent sleep schedule can help reduce migraine frequency.
• Exercise: Some people find exercise worsens their symptoms. But for others, regular exercise can help reduce migraine frequency.
• Eat (food/hydration): Eating regularly, staying hydrated, and avoiding known trigger foods may help reduce migraines.
• Diary: Keeping a symptom diary can help identify potential triggers, patterns, and early warning signs.
• Stress: Managing stress may help reduce the frequency and severity of migraine episodes.

Rescue medications

Your doctor may recommend rescue medications to take at the first sign of a migraine attack. They are generally most effective when taken as early as possible.

Medication

• Pain medications (analgesics) – e.g. aspirin and ibuprofen. These can help manage mild head pain.
• Triptans – e.g. sumatriptan (Imitrex®, Tosymra®). These help stop a migraine attack by targeting migraine-specific pain pathways, and can reduce head pain, nausea, and sensitivity to light and sound.
• Dihydroergotamine – e.g. D.H.E. 45® and Migranal®. This can help stop a migraine attack, particularly when taken early.
• Lasmiditan – e.g. Reyvow®. This can help stop a migraine attack and reduce head pain.
• Antinausea medications – e.g. chlorpromazine and metoclopramide (Reglan®). These can help ease migraine-related nausea and vomiting.

Building a clearer picture of your chronic migraines

Living with chronic migraine often means trying new medications, identifying triggers, and regularly reviewing whether your treatment plan is working. When symptoms happen so frequently, it can be difficult to remember how many headache days you’ve had, whether attacks are becoming less severe, or how well a new medication is working.

Headache days per month are one of the first things your neurologist will ask about. Tracking that number over time helps show whether your condition is improving, staying the same, or becoming more frequent.

Recording your symptoms, medications, and possible triggers alongside headache days also helps you and your doctor assess whether your treatment plan is working and what may need to change.

Using the Human Health app, you can keep all of this information in one place, making it easier to monitor your progress and share accurate, long-term data with your healthcare team.

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Frequently asked questions

What are migraines?

Migraine is a neurological condition that causes recurring attacks of symptoms including head pain, nausea, vomiting, and sensitivity to light and sound. Head pain is often severe and throbbing, commonly affecting one side of the head.

Migraines can last from a few hours to several days, and they often significantly affect a person’s ability to participate in their daily life.

Can the weather cause migraines?

Weather fluctuations like cold weather, bright sunlight, hot, humid air, and sudden changes in barometric pressure can increase some people’s risk of developing a migraine.

Is chronic migraine an autoimmune condition?

Chronic migraine is not an autoimmune condition. However, migraines can be a neurological symptom of some autoimmune conditions that affect the central nervous system, including multiple sclerosis or systemic lupus erythematosus.

Disclaimer: Human Health is a health tracking platform and does not provide medical advice, diagnosis, or treatment. The information in this guide is for educational purposes only and is not a substitute for professional medical care. Always consult your doctor or healthcare provider with questions about your health.

Sources:

1. Chronic migraine, Cleveland Clinic
2. Immunologic aspects of migraine: A review of literature (2022)
3. Chronic Migraine Pathophysiology and Treatment: A Review of Current Perspectives (2021)
4. Headache, The National Institute of Neurological Disorders and Stroke
5. Migraine, The National Institute of Neurological Disorders and Stroke
6. Migraine, MedlinePlus
7. Migraine headache (2024)
8. Chronic migraine, The International Classification of Headache Disorders
9. Episodic and Chronic Migraine Headache: Breaking Down Barriers to Optimal Treatment and Prevention (2015) 
10. Migraine management (2020)
11. Lifestyle changes for migraine management, The American Migraine Foundation
12. Migraine, Mayo Clinic
13. Weather and migraine: is it really a trigger and why?, Migraine Canada