Episodic vs. Chronic Migraine
Migraine can be classified by the 
frequency of monthly migraine days as episodic or chronic. With episodic migraine, people have less than 15 headache days monthly while with chronic migraine, people have greater than or equal to 15 headache days monthly of which 8 days meet the formal criteria for migraine. Chronic migraine is associated with more limitations on one’s daily life and higher resource utilization such as medications, imaging studies, lab work and visits to the doctor or emergency room. Known risk factors for the progression from episodic to chronic migraine include obesity, frequent acute medication use (especially opiates and barbiturates), depression and anxiety amongst others.
The Role of Acute Treatments for the Prevention of Chronic Migraine
While it is clear that preventive medications play a key role in preventing the progression from episodic to chronic migraine, less is out there about the role of acute treatments in this process. Dr. Kuruvilla reviews the optimization of acute migraine medications as a means to prevent progression to chronic migraine. Acute treatments include medications and devices. The available acute treatment medications are triptans, ergots, non-steroidal anti-inflammatory medications, gepants, ditans and nausea medications. Devices discussed include Cefaly, Nerivio, Relivion, Spring TMS and Gammacore. Often as headache physicians, we find that acute treatments are underdosed or not taken optimally at the onset of an attack and repeated. As a result, a single attack can persist for several hours and days. The same headache can go away the same day but only to return the following day. The dosage of acute treatments at optimal dosages, as you tolerate them is key. In many cases, it is helpful to have a multi step approach and have a plan A, plan B, plan C for a single attack in case you do not have freedom from pain, freedom from associated symptoms and freedom from disability after plan A or B. It is also crucial to include standard migraine preventive medications along with acute treatments.
Every person with migraine is different and therefore deserves a customized approach to treatment. Open communication with your doctor is key!
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