Chronic Migraine

11.16.2016 | Teri Robert

What is chronic migraine?

In the simplest of terms, chronic migraine (CM) is defined as: "Headache occurring on 15 or more days per month for more than three months and has the features of migraine headache at least eight days per month." 1

For diagnosing and classifying migraine and other headache disorders, the International Headache Society's (IHS) International Classification of Headache Disorders, 3rd Edition (ICHD-3), is considered the gold standard.

ICHD-3 diagnostic criteria for chronic migraine: 1

  1. Headache (tension-type-like and/or migraine-like) on 15 or more days permonth for more than three months and fulfilling criteria B and C
  2. Occurring in a patient who has had at least five attacks fulfilling criteria B-Dfor 1.1 Migraine without aura and/or criteria B and C for 1.2 Migraine withaura
  3. On eight days per month for more than three months, fulfilling any of thefollowing:
    1. Criteria C and D for migraine without aura
    2. Criteria B and C for migraine with aura
    3. Believed by the patient to be migraine at onset and relieved by atriptan or ergot derivative
  4. Not better accounted for by another ICHD-3 diagnosis.

ICHD-3 criteria B-D for 1.1 Migraine without aura: 1

  1. B.Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)2,3
  2. C.Headache has at least two of the following four characteristics:
    1. unilateral location
    2. pulsating quality
    3. moderate or severe pain intensity
    4. aggravation by or causing avoidance of routine physical activity (e.g.walking or climbing stairs)
  3. D.During headache at least one of the following:
    1. nausea and/or vomiting
    2. photophobia and phonophobia

ICHD-3 criteria B and C for 1.2 Migraine with aura: 1

  1. One or more of the following fully reversible aura symptoms:
    1. visual
    2. sensory
    3. speech and/or language
    4. motor
    5. brainstem
    6. retinal
  2. At least two of the following four characteristics:
    1. at least one aura symptom spreads gradually over 5 minutes or longer, and/or two or more symptoms occur in succession
    2. each individual aura symptom lasts 5-60 minutes
    3. at least one aura symptom is unilateral
    4. the aura is accompanied, or followed within 60 minutes, by headache

The impact and burden of chronic migraine:

Research has shown differences between the impact of episodic migraine and

chronic migraine:

  • The impact of chronic migraine is significantly greater than that of episodic migraine (EM) based on the MIDAS questionnaire (The Migraine Disability Assessment Test). 2
  • Over a three-month period: 2
    • 8.2 percent of subjects with CM reported missing at least five days of work compared to 2.2 percent of subjects with EM.
    • 33.8 percent of subjects with CM reported five or more days of reduced productivity at work compared to 2.2 of subjects with EM.
    • 36.9 percent of subjects with CM reported five or more days of missed family activities compared to 9.5 percent of subjects with EM.
    • 58.1 percent of subjects with CM reported five or more days of reduced productivity in household work compared to 18.2 percent of subjects with EM.

The stigma associated with chronic migraine:

In a study designed to "characterize stigma in patients with chronic and episodic migraines," researchers found: 3

  • Participants with CM scored higher on the Stigma Scale for Chronic Illness scale (SSCI) than participants with EM.
  • Participants with CM also scored significantly higher on the SSCI than a mixed panel of patients with chronic neurologic diseases; stroke, epilepsy, multiple sclerosis, Alzheimer’s, ALS and Parkinson’s disease.

Chronic migraine and social anxiety disorder: 4

  • Research has shown social anxiety disorder to be more prevalent in adults with migraine than adults without migraine.
  • In adolescents "chronic migraine is strongly associated with high social anxiety score, regardless of demographic data and pain intensity. The total burden of migraine may be increased with social anxiety disorder comorbidity."

Health care resources utilization: 5

The most utilized health care resources include:

  • Migraine-specific medications
  • Health care provider visits
  • Emergency room visits
  • Diagnostic testing.

In the United States, 26.2 percent of chronic migraine participants reported visiting a primary care physician in the preceding three months vs. 13.9 percent of episodic migraine participants.

Total mean migraine-related costs for participants with chronic migraine in the U.S. were $1,036 over three months compared to $383 for persons with episodic migraine.


1 Headache Classification Committee of the International Headache Society. “The International Classification of Headache Disorders, 3rd edition (beta version).” Cephalalgia. July 2013 vol. 33 no. 9 629-808.

2 Bigal ME, Serrano D, Reed M, Lipton RB. "Chronic Migraine in the population: burden, diagnosis, and satisfaction with treatment." Neurology. 2008;71(8):559-566.

3 Park J.E.1; Kempner J.2; Young W.B. "The Stigma of Migraine." Poster presentation. 52nd annual meeting of the American Headache Society. Los Angeles. June, 2010.

4 Manrusha, Marcelo R.; Lin, Jaime; Minett, Thais S. C.; Vitalle, Marie Sylvia de S.; Fishberg, Mauro; Vilanova, Luiz Celso P.; Peres, Mario F. P. "Social anxiety score is high in adolescents with chronic Migraine." Pediatrics International vol. 54 no. 3393-396.

5 Stokes, Michael, MPH; Becker, Werner J., MD; Lipton, Richard B., MD; Sullivan, Dean H., PhD; Wilcox, Teresa K., PhD; Wells, Leandra, PhD; Manack, Aubrey, PhD; Prokorovsky, Irina, MSc; Gladstone, Jonathan, MD; Buse, Dawn C., PhD; Varnon, Sepideh F., PhD; Goadsby, Peter J., MD, PhD; Blumenfield, Andrew M., MD. "Cost of Health Care Among Patients with Chronic and Episodic Migraine in Canada and the USA: Results from the International Burden of Migraine Study." Headache 2011;51:1058-1077.