Migraines: Acute versus Chronic?

Migraines are different from other headaches.

Migraines can begin in childhood or may not occur until early adulthood. Women are more likely than men to have migraines. Family history is one of the most common risk factors for having migraines.

This is a neurological condition that can cause multiple symptoms, frequently characterized by intense, debilitating headaches. Symptoms may include nausea, vomiting, difficulty speaking, numbness or tingling, and sensitivity to light and sound. Migraines often run in families and affect all ages.

Migraine symptoms may begin one to two days before the headache itself. This is known as the prodrome stage. Symptoms during this stage can include:

  • food cravings

  • depression

  • fatigue or low energy

  • frequent yawning

  • hyperactivity

  • irritability

  • neck stiffness

The diagnosis of migraine headaches is determined based on clinical history, reported symptoms, and by ruling out other causes. The most common categories of migraine headache are those without aura and those with aura.

In migraine with aura, the aura occurs after the prodrome stage. During an aura, you may have problems with your vision, sensation, movement, and speech. Examples of these problems include:

  • difficulty speaking clearly

  • feeling a prickling or tingling sensation in your face, arms, or legs

  • seeing shapes, light flashes, or bright spots

  • temporarily losing your vision

The next phase is known as the attack phase. This is the most acute or severe of the phases when the actual migraine pain occurs. In some people, this can overlap or occur during an aura. Attack phase symptoms can last anywhere from hours to days. Symptoms of a migraine can vary from person to person. Some symptoms may include:

  • increased sensitivity to light and sound

  • nausea

  • dizziness or feeling faint

  • pain on one side of your head, either on the left side, right side, front, or back, or in your temples

  • pulsing and throbbing head pain

  • vomiting

Episodic migraine (EM) is characterized by those with migraine who have 0 to 14 headache days per month, while chronic migraine (CM) is characterized by 15 or more headache days per month. Specifically, revised ICHD-2 (ICHD-2R) criteria define CM as headache on 15 or more days per month for 3 or more months, of which 8 or more days meet criteria for migraine without aura and/or respond to migraine-specific treatment, occurring in a patient with a lifetime history of at least five prior migraine attacks not attributed to another causative disorder and no medication overuse.

Migraine pain most commonly affects the forehead area. It’s usually on one side of the head, but it can occur on both sides, or shift.

Most migraines last about 4 hours. If they’re not treated or don’t respond to treatment, they can last for as long as 72 hours to a week. In migraines with aura, pain may overlap with an aura or may never occur at all.

After the attack phase, a person will often experience the postdrome phase. During this phase, there are usually changes in mood and feelings. These can range from feeling euphoric and extremely happy, to feeling very fatigued and apathetic. A mild, dull headache may persist.

Depending on how often you experience symptoms, you may be having episodic migraines (EM), acute or chronic migraines (CM). There’s no single test for migraines.

If you go weeks or months between migraine attacks, you may have EM. If you have migraine symptoms on 15 days or more per month, and within at least three months, you may have CM, advises the Mayo Clinic. Most people who experience migraine headaches never develop CM.

An acute migraine is a general term for migraines that aren’t diagnosed as chronic. Another name for this type is episodic migraine. People who have episodic migraines have headaches up to 14 days a month. Thus, people with episodic migraines have fewer headaches a month than people with chronic ones.

 A chronic migraine used to be called combination or mixed headache because it can have features of migraine and tension headaches. It’s also sometimes called severe migraine and can be caused by medication, or over-using medication.

People who have chronic migraines have a severe tension or migraine headache more than 15 days a month for 3 or more months. More than eight of those headaches are migraines with or without aura. 

Compared to people who have acute migraines, people with chronic migraines are more likely to have:

  • severe headaches

  • more disability at home and away from home

  • depression

  • another type of chronic pain, like arthritis

  • other serious health problems (comorbidities), such as high blood pressure

  • previous head or neck injuries

In a study in Current Pain and Headache Reports, researchers found that people with CM experience headaches that last an average of 65.1 hours without treatment and 24.1 hours with treatment.

If you’re experiencing severe headaches with symptoms similar to what is listed above, set up an appointment with a pain specialist for an evaluation.

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