Episodic and Chronic Migraine - The Difference

Patient Expert
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Understanding the difference between episodic migraine and chronic migraine is more than defining the two. We'll start with the definitions and go from there:

  • Episodic migraine can be any form of migraine. When it's episodic, migraine attacks occur with no truly discernible pattern and on fewer than 15 days per month. Episodic migraine can have a bit of a pattern such as occurring around a woman's menstrual cycle.
  • Chronic migraine too can be any form of migraine. Chronic migraine is defined by migraine or headache occurring at least 15 days per month, at least eight of which must meet the criteria for migraine, for a period of three months or longer.

It seems a bit strange to define chronic migraine as "migraine or headache occurring at least 15 days a month, at least eight of which must meet the criteria for migraine." There is, however a logical reason for this. Many experts think that the "headaches" that those of us with chronic migraine get are migraines that don't fully develop with the other symptoms associated with migraine.

Migraine Diagnoses:

Episodic Migraine:

For someone with episodic migraine, a diagnosis of "migraine" is incomplete. A complete diagnosis is one that indicates which form or forms of migraine they have:

Chronic Migraine:

When a migraineur is diagnosed with chronic migraine, that diagnosis doesn't replace their former migraine diagnosis, which would be one or more of the types of migraine listed above.

Treatment:

Preventive:

For the most part, the same treatments are used for both episodic and chronic migraine. For prevention, there are over 100 medications, supplements, and devices in use. Only four medications and one device have been approved by the FDA for migraine prevention. The others are prescribed off-label, a common and trusted practice. The medications and device approved by the FDA are:

  • propranolol (brand name Inderal), a beta blocker
  • timolol, brand Blocadren, another beta blocker
  • divalproex, brand Depakote, an anti-seizure medication
  • topiramate, brand Topamax, an anti-seiqure medication
  • the Cefaly, an external trigeminal nerve stimulator

Botox (onabotulinumtoxinA) was approved by the FDA for the treatment of chronic migraine only in 2010.

Abortive and Rescue:

The same abortive and rescue treatments are used for both episodic and chronic migraine. All migraineurs should have access to both unless they can't take abortive medications for some reason. Even if we have abortive medications that work for us, it would be very rare for them to work every time. Rescue medications are for use if we can't use abortives and for times when our abortives fail. Asking our doctors for rescue medications is not an unreasonable request. If your doctor won't prescribe them and doesn't give an acceptable reason for not prescribing them, it may well be time for a new doctor.

The Right Doctor:

For both episodic and chronic migraine, it's important to work with a doctor who truly understands migraine and how to treat the disease. Unfortunately, doctors are taught very little about migraine and other headache disorders in medical school. If our doctors don't seem to be able to help us, finding a migraine specialist can be the key to better migraine management. It's important to realize that neurologists aren't necessarily migraine specialists, and migraine specialists aren't necessarily neurologists. Learning that and finding a migraine specialist is undoubtedly the best step I've ever taken toward managing my migraines and having a higher quality of life.

Your Migraine Diary:

Keeping an accurate migraine diary is essential. It helps you and your doctor spot patterns, and it's key to knowing if your episodic migraines have transformed to chronic migraine. You can find more information on keeping a migraine diary and a free, downloadable diary workbook in Your Migraine and Headache Diary.

Wrapping It Up:

There are some essential elements to living with both episodic and chronic migraine. They include:

  • The right doctor;
  • the correct diagnosis;
  • learning as much as we can about our migraines and treatments;
  • working closely with our doctors as treatment partners;
  • having access to appropriate preventive, abortive, and rescue treatments;
  • a solid support system; and
  • hope.

Whatever we do, we must not lose hope. We must not give up. It may seem that progress in treatments is slow, and indeed it is, BUT we're making more and more progress. This disease can beat us only if we let it.

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Live well,

PurpleRibbonTiny Teri1

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