Migraine vs. Chronic Migraine: What Are the Differences?

Have you ever experienced a migraine headache? Depending on the frequency of your symptoms, a doctor may make a diagnosis of episodic migraine or chronic migraine.

If you go weeks or months between migraine attacks, you may have episodic migraine. If you’ve gone 3 months or more experiencing migraine symptoms on 15 days or more per month, you may have chronic migraine. Those with chronic migraine may also experience longer episodes.

In the United States, 39 million men, women, and children experience migraine, according to the Migraine Research Foundation. Migraine is the third most prevalent illness worldwide. In fact, headaches are in the top five reasons people visit emergency departments every year.

Episodic and chronic migraine may require different treatment plans. It’s important to speak with your doctor about how many migraine days you have each month. How often you experience migraine headaches may affect your quality of life, response to treatments, mental health, and even financial stability.

Your doctor may make a diagnosis of episodic migraine if you have:

• at least five migraine attacks in your lifetime
• migraine headaches that affect you on fewer than 15 days each month
• episodes that typically last 4 to 24 hours

There’s no single test for migraine. To diagnose episodic migraine, your doctor will ask about your symptoms. Migraine attacks are often only on one side of the head, or unilateral. Some people describe it as a pulsing or throbbing sensation. The pain is often accompanied by:

• nausea
• vomiting
• light sensitivity
• sound sensitivity

Common triggers for episodic migraine include stress, menstruation, and weather changes, among others.

Your doctor will also take steps to rule out other possible causes. For example, you might be experiencing migraine as a side effect of medications or a symptom of an eye disorder or brain injury.

People with chronic migraine experience episodes on more days per month than people with episodic migraine. A doctor may diagnose you with chronic migraine if you have:

• migraine headaches that affect you on 15 or more days each month for 3 months
• migraine symptoms on at least 8 of those days
• episodes that can last more than 24 hours

In a 2012 study in Current Pain and Headache Reports, researchers found that people with chronic migraine experience episodes that last an average of 65.1 hours without treatment and 24.1 hours with treatment.

In comparison, people with episodic migraine have episodes that last an average of 38.8 hours without treatment and 12.8 hours with treatment.

Episodic migraine is more common than chronic migraine. According to the American Migraine Foundation, about 12 percent of Americans have migraine. The Migraine Research Foundation adds that migraine has a higher prevalence in women (18 percent) than in men (6 percent). Studies have found that chronic migraine affects between 3 and 5 percent of Americans.

Prevalence can also vary by race and ethnicity, but this may be due to socioeconomic factors, health inequities, and other variables that may affect stress and anxiety.

For example, a 2021 study noted that unadjusted analyses in earlier research showed that the prevalence of chronic migraine was highest among Black and African American people, Latinx people, and people with low household incomes.

However, after adjusting for multiple variables, the same research found that only household income was linked with higher rates of chronic migraine. This may be because of cost concerns around care.

Women in their 40s appear most likely to experience chronic migraine. This points to a hormonal factor in migraine development. In fact, the National Headache Foundation says that 60 percent of women have migraine attacks around their menstrual cycle.

Other factors related to a higher prevalence of chronic migraine include:

• obesity
• depression
• anxiety
• medication overuse

To treat episodic migraine, a doctor may recommend OTC medications. Depending on the frequency and severity of your symptoms, they may also prescribe medication.

Some preventive medications can help people with episodic migraine have fewer episodes. Treatment to prevent migraine attacks may also reduce headache intensity and cut down on rescue medication use.

Treatment for chronic migraine includes:

• OTC medications to treat an ongoing migraine attack
• prescription medications to treat an ongoing migraine attack
• medications that prevent migraine attacks from happening, called prophylaxis

Medications that can help reduce the frequency, length, or severity of migraine attacks include:

• certain cardiovascular drugs
• antidepressants
• antiseizure drugs
• nonsteroidal anti-inflammatory drugs
• onabotulinumtoxin A (Botox-A)

Most people who experience episodic migraine never develop chronic migraine.

According to a 2012 study in Current Pain and Headache Reports, only 2.5 percent of people with episodic migraine progress to having chronic migraine every year.

It’s also possible to go from having chronic migraine to episodic migraine if your symptoms improve. When symptoms improve, this is called remission.

Migraine headaches are more than just painful. They can also interfere with your ability to participate in daily activities. In fact, migraine is the third leading cause of disability in people under the age of 50, and it’s the second most common cause of lost work days.

If you have chronic migraine, you will likely miss more work and time with your loved ones than you would with episodic migraine. You are also more likely to experience chronic pain, depression, and anxiety. Data from a 2021 report in Headache suggests that the greater the number of headache days you have in a month, the more significant the disability and costs to you.

It’s not just productivity or sick days that are lost as a result of migraine. The cost of medications, office visits, emergency department visits, lab tests, and treatment side effects adds up annually.

Data from 2016 reported in Headache also suggests that chronic migraine is more expensive to treat. It found that people with chronic migraine spend an average of $8,243 per year to treat their condition. People with episodic migraine spend an average of $2,649 per year.

These costs rise if migraine is joined by other conditions, like depression or anxiety. According to a 2021 study in Frontiers in Neurology, people who have migraine with depression and anxiety can expect to spend $11,102 per year to treat these conditions.

Experts hope that new and developing migraine treatments will help free people from the symptoms and burden of migraine.

Over time, migraine can take a toll on your work, income, and even personal relationships. If you’re experiencing headaches on a regular basis, or if you notice other migraine symptoms, talk with your doctor.

Also, make an appointment if you already have a migraine diagnosis and notice your symptoms are becoming more severe or frequent.

A doctor can help you identify the cause of your symptoms. They can also help find the best treatment options for you.