What do we mean by “chronic migraine”?? Episodic migraine is migraine that occurs less than 15 days a month; less than 15 days a month of any sort of headache. Episodic migraine may be 1, 2, 6,9 headaches a month, but certainly not daily or most days. Most people start out with episodic migraine, and many never progress to chronic migraine.
Chronic migraine is headache 15 days or more per month, and a certain number of them have to be migrainous in nature(not necessarily full-blown severe headaches). People usually slowly progress into the chronic stage; a typical history is 1 or 2 headaches per month at age 12 or so, then by age 18 1 or 2 per week, progressing by age 25 to almost daily. Episodic migraines are much easier to treat than are chronic ones.
We want, of course, to prevent people from progressing into chronic daily headaches, but it is not an easy task. Factors that contribute to “chronification” or progression of headaches include: genetics, frequency of headaches to start with, obesity, overuse of pain meds(and possibly triptans), among other factors.
One theory is that, as people(in their teens or 20’s) progress into more frequent headaches, if we use preventive meds earlier, we can prevent chronification. This may be true but is unproven. The problem is that we do not have terrific preventives; at least 50% of people with frequent headaches do not find long-term relief from the preventives. “Early intervention” may be a good concept, but the drugs all have problems; probably our preventives with the least side effects incldue the natural Petadolex, and Botox injections. However, as mentioned these certainly do not work for everyone.

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