Chronic Migraine Treatment

Chronic migraine is defined as experiencing headaches on 15 or more days per month, with features of migraine on at least 8 of those days.

Symptoms can vary considerably between individuals and may include moderate to severe headache; throbbing or pulsating pain; pain affecting one or both sides of the head; nausea or vomiting; sensitivity to light, sound or movement; visual or sensory aura in some patients; neck discomfort associated with migraine; and headaches that interfere with normal daily activities.

Keeping a headache diary can be particularly helpful in establishing how frequently headaches occur, identifying migraine days and assessing the effectiveness of treatment.

Your first appointment is a comprehensive medical consultation rather than simply an appointment for a procedure. Dr Harriet will review your headache history, migraine symptoms, frequency and duration of headaches and the impact they have on your everyday life.

Your assessment will also include your general medical history, current medications, previous migraine treatments and any preventative medications you have already tried.

An important part of the consultation is identifying whether there may be medication overuse contributing to the frequency of headaches. Where relevant, this will need to be addressed as part of your migraine management. The consultation also provides an opportunity to consider whether your symptoms are consistent with chronic migraine and whether further investigation, alternative treatment or referral to another specialist would be more appropriate.

NICE recommends specialist preventative treatment for certain adults with chronic migraine where headaches occur on at least 15 days per month, with migraine features on at least 8 of those days; where at least three previous preventative medicines have not worked, have not been tolerated or are considered unsuitable; and where medication overuse has been appropriately managed.

Suitability for treatment is always determined following an individual medical assessment. If you are not currently keeping a headache diary, you may be asked to do so. This provides a useful baseline against which we can assess both your diagnosis and your response to treatment.

Following consultation, a number of preventative options may be discussed depending on your history and previous treatment. For appropriate patients, one established preventative option involves a prescription medicine administered through a series of small injections into specific muscles of the head and neck.

Unlike treatments used to manage an acute migraine attack, this is a preventative treatment. The aim is to reduce the number of headache and migraine days experienced over time. Treatment follows an established medical injection protocol involving multiple sites across areas of the forehead, temples, back of the head, neck and shoulders. Treatment cycles are generally performed approximately 12 weeks apart, where clinically appropriate.

Migraine treatment should have a measurable benefit, which is why keeping a headache diary before and after treatment is important. We will monitor your total headache days per month, migraine days per month, headache severity, use of acute migraine medication and the impact of migraine on your everyday life.

Guidelines recommend that treatment is discontinued if headache frequency has not reduced sufficiently after two treatment cycles. Specifically, treatment should normally be stopped if there has been less than a 30% reduction in headache days per month after two treatment cycles. NICE also recommends stopping treatment where chronic migraine has improved to episodic migraine, meaning fewer than 15 headache days per month, for three consecutive months. Your response will therefore be reviewed regularly rather than treatment simply continuing indefinitely.

Chronic migraine is a neurological condition and deserves appropriate medical assessment and management. Dr Harriet’s approach is centred around understanding your individual pattern of migraine, reviewing the treatments you have already tried and determining whether further preventative treatment is appropriate.

Treatment is never guaranteed to eliminate migraine completely. The goal is to achieve a meaningful reduction in the frequency and burden of migraine and, ultimately, improve quality of life.

Where your symptoms, examination or medical history suggest that further investigation or specialist neurological assessment is required, this will be discussed with you. That includes a headache pattern that suggests something other than chronic migraine, red-flag features needing urgent investigation, or medication overuse that needs addressing first. Dr Harriet practises as a GP and will be straightforward about when this treatment is not the right answer.