Transformed Migraine - The Basics

Patient Expert

by Teri Robert, MyMigraineConnection Lead Expert

Transformed Migraine (TM) is Migraine which began manifesting in episodic Migraine attacks, increasing in frequency and changing characteristics, and resulting in almost daily less severe headaches punctuated by severe and debilitating Migraine attacks.

Patients with Transformed Migraine often share these characteristics:

  • A history of episodic Migraine beginning in their teens or twenties.
  • Most are women, 90% of whom have a history of Migraine with aura.
  • Medication overuse.

The process of transformation is often characterized by:

  • Migraine attacks that became more frequent over a period of months or years.
  • These attacks were accompanied by phonophobia, photophobia, and nausea, but these symptoms became less severe and less frequent.

Characteristics of Transformed Migraine:

  • A pattern of daily or almost daily headaches that seem to be a mixture of tension-type headaches and Migraine attacks.
  • Pain that drops in severity to mild to moderate.
  • Pain isn't always accompanied by phonophobia, photophobia, or nausea.
  • Other Migraine symptoms may persist including unilateral pain, gastrointestinal symptoms, and aggravation by other triggers.


"Normal" episodic Migraines can increase in frequency and change in characteristics to produce almost daily headaches in addition to severe Migraine attacks. Medication overuse is a factor in approximately 80% of Transformed Migraine cases. Treatment generally involves discontinuing medications that are being overused and working to find effective preventive regimens. Often, when medication overuse is solved, the daily headache subsides and the Migraines return to being episodic and more easily managed.


Silberstein, Stephen D, M.D.; Burstein, Rami, Ph.D.; Dodick, David W., M.D.; Lipton, Richard B., M.D. "Understanding the Clinical Features, Biology, and Management of Transformed Migraine: The Evidence Base." Continuing Education. Annual Scientific Meeting of the American Headaches Society. Boston. June, 2005.

Goadsby, Silberstein, Dodick. "Chronic Daily Headache for Clinicians." BC Decker, Inc. London. 2005.