Migraines are one of the most common, but also misunderstood, ailments a person can suffer from at some point in their lives, with 12% to 15% of the population worldwide suffering from them at any point in time.
Chronic migraine headaches are rarer but still affect up to 2.2% of the population, meaning millions of people every day. And they can have a debilitating impact on individuals, affecting their daily lives and overall well-being.
But what are they? We’re here to provide a comprehensive understanding of the causes and potential risk factors, like bruxism or teeth grinding, genetics, and symptoms and treatments associated with chronic migraines.
It is crucial to empower those suffering from this medical condition with knowledge about various treatment options, including medication and lifestyle modifications. By providing valuable insights and guidance, we seek to support individuals in finding medical treatment for relief and improving their quality of life.
What Are Migraines?
First off, let’s define what exactly migraines are. They are a type of headache characterized by severe pain, often on one side of the head, along with other neurological symptoms such as nausea, vomiting, and sensitivity to light and sound. They are more than just a bad headache that can last for hours or even days and can significantly impact a person’s quality of life. In cases like a hemiplegic migraine, it can even cause paralysis temporarily on one side of the body, even prior to a headache days before.
The main forms of migraine are the following:
- Without aura
- With aura (formally known as a classic migraine.)
- Hemiplegic migraine
- Vestibular
- Retinal migraine
- Menstrual
- Episodic
- Cluster headache (sometimes classified as a type of migraine.)
- Ophthalmoplegic
- Status migrainous
Understanding the definition and characteristics of this type of pain is essential in order to properly diagnose and treat this condition.
Chronic Migraine Definition
Chronic migraines, also known as recurring severe headaches, are a neurological condition characterized by frequent migraines with intense pain and various accompanying symptoms. Unlike regular headaches, chronic migraines are severe, frequent headaches that last for extended periods, typically up to 72 hours.
These debilitating headaches can occur multiple times a month, significantly impacting the quality of life for those affected. Women are also more likely to be affected by them, with up to 4% of women having chronic types of migraines (possibly because of the normal changes during their menstrual period), compared to just 0.6% to 0.7% of men.
They are sometimes confused with episodic migraines. An episodic migraine is less frequent than a chronic one, but they share most of the same symptoms, including one-sided headache, light sensitivity, nausea, and auras. They might either go away with time or increase in frequency and become a chronic problem. In fact, between 26% and 70% of chronic migraines revert to episodic types in the long term.
The exact causes of the chronic type of migraine are still not fully understood, but they are believed to be a combination of genetic and environmental factors. Hormonal changes, certain foods, stress, and sleep disturbances have also been identified as triggers for them, which we will explore further.
The symptoms of chronic migraines can go beyond the throbbing pain, including sensitivity to light and sound, nausea, and vomiting. Treatments may include medication, lifestyle changes, and alternative therapies such as acupuncture or biofeedback.
Chronic Migraine Symptoms
Chronic migraine symptoms can vary from person to person, but some common signs include:
Difficulty concentrating
One common symptom is a noticeable difficulty in maintaining focus and concentration. This can be quite frustrating and disruptive to daily life activities.
The constant presence of head pain can make it challenging to concentrate on tasks, whether at work, school or even during social interactions. The intensity and duration of these severe chronic headaches can vary from person to person, but difficulty concentrating is a frequent complaint among sufferers.
Severe Headache
Experiencing a debilitating and persistent headache is one of the prominent symptoms associated with any migraine, especially chronic ones. These severe headaches can cause immense discomfort and significantly impact daily life. Chronic migraine headaches are characterized by recurring episodes of throbbing or pulsating pain, often on one side of the head. They can last for hours or even days, causing sensitivity to light and sound, nausea, and vomiting, which themselves are other symptoms of these types of migraine headaches.
Throbbing or Pulsating Pain
Throbbing or pulsating pain is a common symptom experienced by individuals with chronic migraines and the main characteristic of overall migraine pain. This type of pain is often described as a rhythmic pulsation that can be felt on one or both sides of the head. It can be intense and debilitating, causing individuals to seek relief and interrupt their daily activities, hoping also to avoid the common triggers of these severe headaches. Extreme cases can even see a loss of consciousness as a result of the pain.
Nausea and Vomiting
Nausea and vomiting are common migraine symptoms associated with the chronic type as well, further adding to the debilitating nature of this condition. Many individuals who suffer from chronic headaches experience these distressing symptoms alongside a loss of balance and the throbbing or pulsating pain in their head. Upwards of 80% of people will report having nausea together with their head pain, with almost half of them vomiting. The description of this symptom is almost identical to cases of motion sickness.
The exact cause of nausea and vomiting in relation to migraines is not fully understood, but it is believed to be related to the activation of specific brain areas involved in the regulation of nausea and vomiting.
Certain triggers, such as bright lights, strong odors, or certain foods, can exacerbate nausea.
Visual Disturbances (auras)
Visual disturbances, commonly known as auras, frequently accompany chronic migraine headaches. According to the American Migraine Foundation, 20% to 30% of individuals with migraine present this symptom at any time or during every attack they have. These visual disturbances can manifest as flickering lights, blind spots, blurred vision, or zigzag lines in the field of vision. In some extreme cases, there can even be a total or partial loss of vision. They usually occur before the onset of a migraine and can last anywhere from a few minutes to an hour, and prompt many of those who suffer from them to seek medical attention as soon as possible.
Auras are believed to be caused by changes in the electrical activity of the brain, specifically in the visual cortex. It is important to note that not all individuals with chronic migraines experience auras, but for those who do, they can be quite distressing.
Sensitivity to Light
The sensitivity to light is a common symptom experienced by individuals with chronic migraine headaches. It is also known as photophobia and can occur during both episodic and chronic migraines it is typically the result of being exposed to bright lights, such as sunlight or fluorescent lighting, which can trigger or worsen the headache.
This sensitivity to light can cause discomfort, pain, and even nausea. In some cases, it may also lead to other visual disturbances, such as seeing flashing lights or experiencing double vision.
Sound Sensitivity
Like with light, sufferers can also experience sound sensitivity, where even the slightest sound from the television or a conversation can cause discomfort or pain. The exact causes of sound sensitivity in chronic migraines are not fully understood, but it is believed to be related to the abnormal processing of sensory information in the brain.
When sound sensitivity occurs, even everyday noises can become overwhelming and painful for migraine sufferers. Symptoms of sound sensitivity include discomfort or pain in response to loud or repetitive sounds, difficulty concentrating, and irritability.
To manage sound sensitivity during chronic migraines, it is important to create a quiet and calm environment, wear earplugs or noise-canceling headphones, and avoid exposure to loud noises.
Fatigue
One common type of chronic migraine symptom is fatigue, which refers to a persistent feeling of tiredness or lack of energy that can significantly impact daily activities.
Fatigue is often experienced as a result of the intense pain and other associated symptom with migraine headaches. The exact causes of fatigue in chronic migraines are not fully understood, but it is believed to be related to the neurochemical changes that occur during an attack.
Fatigue can also be a symptom of medication overuse, a common issue in the treatment of many types of migraine.
The Four Stages of Migraines
Migraines typically progress through four distinct stages: prodrome, aura, attack, and postdrome.
Each stage presents unique symptoms and characteristics, so recognizing these stages can help individuals better anticipate and manage their migraines.
Prodrome
Patients experiencing chronic migraine headaches often encounter a prodrome phase, which frequently precedes the actual onset of the migraine attack. This first stage is characterized by a range of symptoms that can serve as warning signs hours or even days before the actual attack begins.
Common prodrome symptoms include mood changes, fatigue, food cravings, neck stiffness, and increased thirst and urination. The exact cause of prodrome is not fully understood, but it is believed to be related to changes in brain chemistry and blood flow.
Aura
The second stage is the aura stage, characterized by a range of sensory disturbances that can occur prior to the onset of a migraine attack. During this stage, individuals may experience various symptoms that can affect their vision, among other things already detailed above as a symptom.
However, it is important to note that not everyone who experiences migraines will have an aura stage. However, for those who do, recognizing these symptoms can be helpful in preparing.
Attack
During the attack stage, also known as the intense “headache phase”, individuals experience severe headache pain along with additional symptoms that can significantly impact their daily functioning. This is the most debilitating phase, typically lasting from a few hours to several days.
The headache pain is often described as throbbing or pulsating and is usually accompanied by sensitivity to light, sound, and even certain smells. Nausea and vomiting are also common during this headache phase.
Physical activity tends to worsen the symptoms, forcing individuals to seek a quiet and dark environment to find relief.
Postdrome
After experiencing the debilitating attack phase of chronic migraine headaches, individuals often enter the postdrome stage, which marks the final phase of the migraine episode. This stage is commonly referred to as the ‘migraine hangover’ and can last anywhere from a few hours to a couple of days.
During this time, individuals may experience a range of symptoms, including fatigue, difficulty concentrating, mood changes, and continuing sensitivity to light and sound, but mercifully no pain.
It is important for individuals in the postdrome stage to take care of themselves by getting enough rest, staying hydrated, and eating healthy foods. Avoid triggers during this phase, such as bright lights, strong smells, and certain foods.
Possible Causes of Chronic Migraines
The medical science is still out on what exactly causes these intense and severe headaches because the answer is “many things” and depends on each case. However, most healthcare providers have described a brain suffering from migraines as being “hyperactive” or “supersensitive” to environmental stimuli or as a result of other medical conditions.
With that in mind, possible causes of chronic migraines can include:
Bruxism or Teeth Grinding
One potential cause of chronic migraines is bruxism, a condition characterized by the grinding or clenching of teeth. Bruxism often occurs during sleep and can be a result of stress, anxiety, or misaligned teeth. Many individuals may be unaware that they are grinding or clenching their teeth, as it often happens unconsciously.
However, over time, bruxism can lead to chronic migraines due to the constant pressure and tension placed on the jaw muscles and joints. The excessive force exerted by bruxism can cause headaches that radiate to the temples, forehead, and even the neck.
TMJ
The relationship between bruxism and chronic migraines extends to the potential involvement of temporomandibular joint (TMJ) dysfunction. TMJ is the joint that connects the jawbone to the skull. When this joint is not functioning properly, it can lead to a variety of symptoms, including secondary headaches and migraines.
TMJ dysfunction can occur due to various factors, such as misalignment of the jaw, muscle tension, or trauma to the joint. When the TMJ is affected, it can cause pain and discomfort in the jaw, face, and head, which may trigger chronic migraines.
Genetics & Family History
Research indicates that individuals with a family history of migraine attacks are more likely to experience chronic migraines themselves. One study found that if one parent has a history of migraines or headaches, their child has an even chance (50%) of getting them too.
This suggests that certain genes may be responsible for increasing the risk of developing these debilitating headaches.
Understanding the genetic factors involved in chronic migraines can help healthcare professionals provide more personalized treatment options for their patients. By identifying specific genetic markers or your family’s medical history, doctors can determine the most effective medications and therapies for each individual.
Depression
Chronic migraines and depression often coexist, with research suggesting that individuals with depression are more likely to experience them.
The relationship between the two conditions is complex and multifaceted. Depression may act as a trigger, as the emotional stress and physical symptoms associated with depression can lead to increased headache frequency and intensity. The neurotransmitters involved in depression, such as serotonin, may also play a role in the development of migraines.
It is important to address both depression and migraines simultaneously, as treating depression can potentially reduce the frequency and severity of migraines. A comprehensive treatment plan that includes therapy, medication, and lifestyle modifications can help individuals manage both conditions effectively.
Anxiety
Anxiety is a common mental health condition that affects millions of people worldwide. It is characterized by persistent feelings of worry, fear, and unease. And research suggests that individuals with anxiety may be more prone to experiencing chronic migraines.
The exact relationship between anxiety and migraines is not fully understood, but it is believed that anxiety can trigger or make them more frequent and severe.
The stress and tension associated with anxiety can lead to muscle tension, including in the head and neck, which can contribute to the development of tension-type headaches and worsen to migraines.
Anxiety may also affect certain brain chemicals and neurotransmitters that play a role in migraine development.
Brain Chemistry Changes
An emerging area of research suggests that alterations in brain chemistry may be a contributing factor to the development of chronic migraines. It is believed that changes in neurotransmitters, such as serotonin and dopamine, may play a role in the onset and persistence of these debilitating headaches.
As mentioned above in depression as a cause, serotonin, in particular, has been found to regulate pain pathways in the brain, and its deficiency has been linked to an increased susceptibility to migraines.
Other imbalances in neurotransmitters, such as glutamate and GABA, have also been implicated in the development of chronic migraines.
Sleep Disorders
Sleep disorders, such as insomnia, sleep apnea, and restless leg syndrome, can disrupt the quality and quantity of sleep, leading to an increased risk of developing chronic migraines. People with migraine often have trouble sleeping as well, leading to a dangerous cycle of cause and effect.
Insomnia, characterized by difficulty falling asleep or staying asleep, can cause fatigue and trigger migraines. Sleep apnea, a condition where breathing repeatedly stops and starts during sleep, can reduce the amount of oxygen reaching the brain, potentially triggering migraines. Restless leg syndrome, which causes an uncontrollable urge to move the legs, can disrupt sleep and contribute to the development of migraines.
Hormonal Changes
Hormonal fluctuations, particularly in women, have been linked to an increased frequency and severity of migraines. The menstrual cycle, pregnancy, and menopause are periods of significant hormonal changes that can trigger migraines.
Estrogen, a hormone that fluctuates during these times, has been found to be an important factor in women with migraine.
Moreover, hormonal contraceptives can also influence migraines. It is important for individuals experiencing chronic migraines to monitor and understand their hormonal changes and their potential impact on headache patterns.
Medication Overuse Headaches (MOH)
How can medication overuse lead to chronic migraines?
Medication Overuse Headache (MOH) is a condition that can occur when patients overuse medications, such as pain relievers, to manage their migraines. While these medications may provide temporary relief, their excessive use can actually worsen the frequency and intensity of migraines, leading to a chronic migraine condition.
MOH occurs when medications are used for more than 10 to 15 days per month or for an extended period of time. The exact mechanism behind MOH is not fully understood, but it is believed that overusing medications can disrupt the brain’s pain regulation systems and changes in blood pressure, making it more susceptible to migraines.
Head Injuries or Concussions
Chronic migraines can also be a result of head injuries such as concussions due to the impact and trauma caused to the brain. The traumatic brain injury disrupts the normal functioning of the brain, leading to increased sensitivity to stimuli and changes in brain chemistry. This can trigger recurring migraine attacks characterized by severe headaches, nausea, and sensitivity to light and sound.
Foods and Additives
Certain foods or food additives have been known to trigger migraines in susceptible individuals, possibly because they are allergic to the chemicals in them or for other secondary reasons.
One common trigger is tyramine, which is found in aged cheeses, cured meats, and fermented foods.
Tyramine causes blood vessels to constrict and then expand, leading to migraine headaches. Another common trigger is monosodium glutamate (MSG), a flavor enhancer found in many processed and pre-packaged foods. MSG can overstimulate nerve cells in the brain, leading to migraines in some people.
Food dyes, such as tartrazine (Yellow 5) and erythrosine (Red 3), have also been linked to migraines.
These artificial colorings can cause the release of histamine, a compound that can trigger migraines in sensitive individuals. In addition, some people may be sensitive to specific food groups like dairy, chocolate, caffeine, or alcohol, which can also act as migraine triggers. It is important for individuals who experience migraines to identify and avoid their specific trigger foods in order to manage their condition effectively.
Chronic Migraine Treatments
When it comes to treating chronic migraines, there are several options available for preventive treatment and migraine care for overall health improvements, although getting to the root cause of these severe and frequent headaches will require a multifaceted approach. There is no single cure for migraine, but there are several treatments that offer a long respite and quality of life improvements.
In some cases, medical procedures may be recommended as a treatment of migraine.
Migraine Care and Preventive Medications
The use of preventive medication is a crucial aspect of chronic migraine treatment. Preventive medications are prescribed to individuals who experience frequent and severe migraines, with the goal of reducing the frequency, intensity, and duration of these debilitating headaches.
Common preventive medicine treatments for migraines for chronic migraines include beta-blockers, antidepressants, anticonvulsants, and even Botox injections. These medications aim to reduce the frequency and severity of migraine attacks, improving the quality of life for those suffering from chronic migraines.
Beta-blockers, such as propranolol, work by blocking the effects of stress hormones on blood vessels, thereby preventing migraines. Antidepressants, like amitriptyline, can also help manage chronic migraines by altering the levels of certain brain chemicals involved in pain transmission.
Anticonvulsants, such as topiramate, are commonly prescribed for chronic migraines due to their ability to stabilize the excitability of nerve cells. Furthermore, Botox injections have been found to be effective in preventing chronic migraines by reducing muscle contractions and blocking pain signals.
It is important to note that preventive medications may take several weeks or months to show their full effect, and their effectiveness can vary from person to person. These medications may have side effects on blood pressure and other critical systems, so it is crucial to work closely with a healthcare professional to find the right medication and dosage that works best for each individual.
These medications, when used in combination with lifestyle changes and other non-pharmacological interventions, can significantly alleviate the burden of chronic migraines.
Treating Migraines by Treating Bruxism
One effective approach to treating chronic migraines is addressing the underlying issue of bruxism. Bruxism, also known as teeth grinding or clenching, can contribute to the development and exacerbation of migraines. When individuals grind or clench their teeth, it puts excessive pressure on the jaw, muscles, and nerves, leading to tension and pain that can trigger migraines. By treating bruxism, healthcare professionals can help alleviate chronic migraines.
There are various treatment options available for bruxism, including dental devices, medications, and behavioral therapy. Dental devices, such as mouthguards or splints, can help protect the teeth and jaw joint during sleep and prevent grinding. Medications like muscle relaxants or antidepressants can also be prescribed to reduce muscle tension and relax the jaw.
Also, behavioral therapy techniques, such as relaxation exercises or stress management, can help individuals manage bruxism and decrease the frequency and intensity of migraines.
Medical Procedures for Chronic Migraine Treatment
Several medical procedures can be utilized for the acute treatment of chronic migraines. These procedures aim to provide relief from the debilitating symptoms of chronic migraines and improve the quality of life for those affected.
One such procedure is nerve block injections, where a local anesthetic is injected into specific nerves associated with severe headache pain, like the vagus nerve or trigeminal nerve. The trigeminal nerve is key, as it helps regulate pain in the head and neck.This helps to numb the nerves and reduce the frequency and intensity of episodes.
Another procedure is Botox injections, which involve injecting small doses of Botox into specific muscles of the head and neck. This helps to relax the muscles and prevent them from contracting, which can trigger migraines.
Additionally, there are surgical procedures available for chronic migraine treatment, such as decompression surgery, where the nerves responsible for migraines are relieved from pressure or irritation.
These medical procedures offer hope and potential relief for individuals suffering from chronic migraines.
Don’t Let Bruxism or Chronic Migraines Ruin Your Life and Seek Treatment
By adopting a multidisciplinary approach, individuals can explore various treatment methods, ranging from medication to lifestyle modifications, to find relief. Preventive measures can be taken to reduce the frequency and severity of these headaches. And above all else, seeking timely treatment for your chronic migraine is key.
So, with the right knowledge and support, individuals can effectively navigate the complexities of chronic migraines and improve their overall well-being.
Frequently Asked Questions
Can Chronic Migraines Be Triggered by Environmental Factors?
Various environmental factors can be migraine triggers, although this is rarer and not normally thought of as a cause of chronic severe headaches unless the triggers are a constant in a person’s life. These triggers may include certain foods, strong odors, bright lights, changes in weather or barometric pressure, and of course, stress. Identifying and avoiding these triggers can help manage and prevent any type of migraine.
Are There Any Natural Remedies or Alternative Treatments for Chronic Migraines?
There are several natural remedies and alternative treatments available for migraines, including acupuncture, herbal supplements, and relaxation techniques. These options can provide relief and help manage symptoms in a more holistic and non-pharmacological way but might not offer long-term relief for chronic pain.
