Chronic migraine means headache on 15 or more days a month for more than 3 months ¹. Some people move from episodic to chronic migraine, and many move back with the right care.

Factors linked to progression

Research links the move to chronic migraine with frequent attacks, overuse of acute medication, obesity, sleep problems, depression and anxiety, stress, and high caffeine intake ². Many of these are things you can work on.

Medication overuse headache

Taking pain relievers or migraine rescue medicines too often can make headaches more frequent. This is called medication overuse headache (MOH). As a general guide, the risk rises with:

• Simple pain relievers (like ibuprofen or acetaminophen) on 15 or more days a month
• Triptans, combination pain relievers or opioids on 10 or more days a month ^1,3

Opioids and barbiturate-containing products carry a particularly high risk ^4,5. Estimates suggest MOH affects about 1.5 to 3% of people, but it is highly disabling ⁶.

The good news

MOH is treatable. Education, a structured reduction of the overused medicine under medical supervision, and starting preventive strategies can lead to major improvement ^3,7. Some people can do this with simple advice, while others need more support ^8,9.

Important: never stop a prescribed medication on your own. Work with your prescribing physician on any change.

Is it changing my brain?

Some imaging studies have found small white-matter spots in people with migraine, and researchers are still clarifying what they mean for long-term outcomes ¹⁰. Reducing attack frequency remains the goal.

Research cited on this page

1. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38(1):1-211. Source · DOI
2. Su M, Yu S. Chronic migraine: A process of dysmodulation and sensitization. Mol Pain. 2018;14:1744806918767697. PubMed 29642749 · DOI
3. Diener HC, Holle D, Dresler T, et al. Chronic Headache Due to Overuse of Analgesics and Anti-Migraine Agents. Dtsch Arztebl Int. 2018;115(22):365-370. PubMed 29932046 · DOI
4. Schwedt TJ, Alam A, Reed ML, et al. Factors associated with acute medication overuse in people with migraine: results from the 2017 migraine in America symptoms and treatment (MAST) study. J Headache Pain. 2018;19(1):38. PubMed 29797100 · DOI
5. Thorlund K, Sun-Edelstein C, Druyts E, et al. Risk of medication overuse headache across classes of treatments for acute migraine. J Headache Pain. 2016;17(1):107. PubMed 27882516 · DOI
6. Steiner TJ, Stovner LJ, Vos T, et al. Migraine is first cause of disability in under 50s: will health politicians now take notice?. J Headache Pain. 2018;19(1):17. PubMed 29468450 · DOI
7. Munksgaard SB, Madsen SK, Wienecke T. Treatment of medication overuse headache-A review. Acta Neurol Scand. 2019;139(5):405-414. PubMed 30710346 · DOI
8. Nielsen M, Carlsen LN, Munksgaard SB, et al. Complete withdrawal is the most effective approach to reduce disability in patients with medication-overuse headache: A randomized controlled open-label trial. Cephalalgia. 2019;39(7):863-872. PubMed 30732459 · DOI
9. Benz T, Nüssle A, Lehmann S, et al. Health and quality of life in patients with medication overuse headache syndrome after standardized inpatient rehabilitation: A cross-sectional pilot study. Medicine (Baltimore). 2017;96(47):e8493. PubMed 29381924 · DOI
10. Xie H, Zhang Q, Huo K, et al. Association of white matter hyperintensities with migraine features and prognosis. BMC Neurol. 2018;18(1):93. PubMed 29966519 · DOI