If you’ve ever experienced a migraine headache, you understand the excruciating migraine pain and debilitating symptoms that can accompany it. Migraines are a prevalent and often misunderstood neurological disorder, affecting 39 million people in the United States alone. They are the third most prevalent illness worldwide and rank among the top reasons for emergency department visits. They can have a very negative impact on your quality of life.
One of the critical distinctions in diagnosing migraines is whether they are classified as episodic or chronic. In this blog post, we’ll look at episodic migraine vs chronic migraine, the implications of these distinctions, and the various treatments available for these severe headaches.
Episodic Migraine vs. Chronic Migraine: What Sets Them Apart?
Frequency Matters
The primary factor and main difference distinguishing these two types of migraines is the frequency of migraine attacks and the number of overall headache days. Keeping a migraine journal can be helpful at tracking your headache frequency. Episodic migraines occur when you experience migraine symptoms on fewer than 15 days each month. In contrast, chronic migraines are diagnosed when the number of headache days is 15 or more days per month, with at least 8 of those days having migraine features, for at least 3 consecutive months. The high migraine frequency of chronic migraine accounts for the significant difference in negative impact on daily life.
Duration of Pain
Episodic migraines typically last between 4 to 72 hours (untreated or unsuccessfully treated) and have longer periods of pain free days and time between attacks. Chronic migraines can be continuous with fluctuating levels of severity through the month for 15-30 days, and have much fewer headache free days between attacks.
Treatment Approaches
The treatment approach also varies between episodic and chronic migraines. Episodic migraines may be managed with a simple acute treatment strategy with over-the-counter (OTC) medications, triptans, or gepants, and sometimes (but not always) preventive treatments. On the other hand, chronic migraines require a more comprehensive and aggressive approach involving strategic treatment combinations including prescription medications for both abortive and preventive treatments.
Severity and Comorbidities
Chronic migraines are more likely to be accompanied by severe pain and comorbid conditions like depression and anxiety compared to episodic migraines.
Characteristics of Episodic Migraine
Your doctor may diagnose you with episodic migraine if you meet the following criteria:
- You’ve experienced at least five migraine attacks in your lifetime.
- Migraine headaches occur on fewer than 15 days each month.
- Migraine episodes typically last between 4 to 72 hours.
Episodic migraines often have common triggers such as stress, menstruation, and weather changes. Diagnosis is usually based on symptom descriptions and ruling out other possible causes.
Characteristics of Chronic Migraine
Chronic migraines are diagnosed when:
- Migraine headaches occur on 15 or more days each month for three consecutive months.
- You experience migraine symptoms on at least 8 of those days.
- Episodes can last multiple days with few headache free days in between attacks.
Research shows that chronic migraine episodes can be significantly longer, with or without treatment, compared to episodic migraines.
Prevalence and Demographics
More people have occasional episodic migraines than constant chronic migraines, with 1 in 6 Americans getting them. Women get them more often, with 1 out of 5 women compared to 1 out of 16 men. Migraine affects 39 million in the US and 1 billion globally. 1 in 4 households in the US has someone with migraine. Things like race, background, family history, and money can affect how often someone gets migraines. Women can often have frequent migraines because of hormone changes during their periods. Being overweight, feeling down or worried, and taking too much medicine can also be reasons.
Treatment Options
Effective treatment is essential to manage both episodic and chronic migraines. It is important to know that the more episodic migraine continues without an effective abortive and preventive treatment strategy, the more likely it will continue to slowly evolve over time into chronic migraine. So, an early treatment plan is key to trying to prevent evolution into chronic migraine. Once the chronic migraine stage is reached, it is important to get aggressive with treatments to try to reverse the course of progressive worsening. There are many very effective migraine abortive and preventive treatment options proven to be effective through clinical trials and systematic reviews.
- Episodic Migraine Treatments: This typically involves OTC medications such as nonsteroidal anti-inflammatory drugs, with prescription acute migraine medications such as triptans and gepants considered based on symptom severity. Preventive medications may also be recommended.
- Chronic Migraine Treatments: Managing chronic migraines often requires a multifaceted approach beyond OTC meds, including prescription medications. Preventive measures are crucial to reduce the frequency, length, and intensity of migraine attacks. These migraine preventives may include cardiovascular drugs, antidepressants, antiseizure drugs, gepants, calcitonin gene-related peptide (CGRP) monoclonal antibodies, and even botulinum toxin type A (Botox-A).
Can Episodic Migraine Progress to Chronic Migraine?
While episodic migraine is more common, not everyone with episodic migraine progresses to chronic migraine. In fact, only 2.5-3% of episodic migraine sufferers transition to chronic migraines each year.
Additionally, some individuals with chronic migraines may experience periods of remission, where symptoms improve and revert to episodic migraines. However, if you have episodic migraines that have higher rates of frequency, they will more often tend to continue worsening unless you have a good abortive and preventive treatment strategy in place. They tend to start “feeding into themselves.” So, this is very important to monitor.
The Impact of Migraines on Your Life
Severe migraine can make day-to-day life hard. They can make it tough to go to work, keep a job, or have good relationships. It’s hard to work when you’re stuck in chronic pain with a bad headache on the side of the head with visual disturbances of zigzag lines or flashing lights! They are a top reason why people under 50 can’t work sometimes. People with chronic migraines are more likely to miss work and feel pain, sadness, and worry a lot. Treating chronic migraines is often more expensive than treating episodic ones.
On average, people with chronic migraines spend a lot of money on treatments every year, while those with episodic migraines spend less. The costs can be even higher if migraines come with other problems like feeling sad or worried.
Find Help and Relief With Virtual Headache Specialist
Migraines can have a profound impact on your life, affecting not only your health but also your finances and overall well-being. If you experience headaches frequently or notice worsening symptoms, don’t hesitate to seek medical help. A healthcare provider can help identify the cause of your migraines and tailor the most effective treatment plan for you.
For further assistance and personalized insights into your migraine condition, consider visiting Virtual Headache Specialist™. We offer free tools for personalized self-research on your headache or facial pain. Our resources include a free symptom checker, educational pages, and a blog covering everything you need to know about migraines, headaches, and facial pain. With this information, you can have a more productive discussion with your local doctor about your headache disorders and potential treatments, all without any charges or fees. Don’t let migraines control your life. Use these free educational tools that we offer to develop a fine-tuned treatment strategy with your doctor.
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