Episodic Migraine, Treatment, Causes And Difference with Chronic Migraine

Episodic Migraine And Chronic Migraine
9 min reading time

Episodic migraine (EM) and chronic migraine (CM) describe the frequency of migraine attacks. People with 0-14 headache days per month are diagnosed with episodic, and those with 15 or more headaches per month have chronic Migraine.

Many patients suffer from chronic migraine (CM), while others suffer from episodic migraine (EM). Both of them cause intense headaches. However, the headache patterns are different. Recently doctors and researchers have discovered more similarities between episodic migraine and chronic migraine. Below are detailed insights for each type of headache, with the essential differences highlighted.

Nevertheless, before delving into the subject matter, it is pertinent to explore the concept of episodic migraine.

What Is Migraine 

A migraine is a type of very intense headache often accompanied by nausea. They sometimes come with feelings of unease and sensitivity to light and sound. Migraine headaches characteristically occur on both sides of the head and cause nausea. Additionally, they are triggered by hormonal changes, certain foods, drinks, stress, or exercise.

Headache disorders are quite common, and according to the World Health Organisation (WHO), headaches affect about 1.7–to 4% of the world’s population. Additionally, it occurs in all countries across all cultures.

Migraine attacks document back to ancient times. People who have migraines often find ways to cope with the symptoms. However, for those affected by migraine attacks, migraines can interfere with daily activities and significantly affect their lives. It is most common between the ages of twenty and fifty-nine years old. Additionally, according to the Migraine Research Foundation, women are three times more likely than men to develop migraine headaches most especially with sanpaku eyes.

Types Of Headache Disorders

A headache can be caused by a wide variety of conditions, ranging from common to extremely rare. Many specific types of headaches are recognizable and diagnosed by a physician. Below are the significant types of headache disorders.

1. Migraine

Most cases of migraine disorders start in childhood, adolescence, or early adulthood. Migraine is 3 to 4 times more common among women than men. Two-thirds of people with migraine experience moderate to severe headaches. 

2. Tension-type headache

The most commonly reported headache type is tension-type headache, comprising about 80% of cases.

TTH is characterized by bilateral aching or pressure-like headaches, chronic and recurrent.

3. Cluster headache

Cluster headache is a form of primary headache that usually responds well to treatment. It makes the sufferer feel pain on one side of the head like a tight band around the head.

An inherited syndrome in which headaches are often accompanied by inflammation of blood vessels in the brain.

Phases Of Episodic Migraine

In order to understand the difference between migraine with aura and without aura, migraineurs first need to understand that headaches are classified into types or migraine categories. This basic classification is the headache status.

Prodrome phase

About half of people with migraines have prodromal symptoms before a full-blown attack develops. Prodrome is the first phase of a migraine. It shows within hours or even days prior to the migraine.

During this phase, you might experience constipation, diarrhea, or difficulty sleeping.

Migraine aura

This is the temporary loss of normal brain function. It’s a disturbance to how you see, hear, move, and feel. Users may experience hallucinations, distorted visions, blind spots, or tingling in the arms and legs. This last from minutes to several hours.


Migraine pain most often is on one side of the head and usually lasts from four to 72 hours. But attacks also can come in waves that occur repeatedly over a period of weeks or months.


This phase of episodic migraine is characterized by general fatigue, clumsiness, and irritability.

Epidemiology of Chronic Migraine Versus Episodic Migraine

The epidemiology of chronic migraine involves a huge cost to society. Both in terms of direct medical treatment costs and indirect costs arising from suffering, job disability, and loss of productivity. As such, the disease is more prevalent than most people think.

Migraine is a severe and debilitating type of headache affecting people in all age groups. Those who suffer from migraine attacks regularly for several days to weeks may eventually develop chronic migraine. However, since the mechanisms underlying the transformation from episodic headaches to chronic ones are not yet precise, it is essential to understand the epidemiology of both conditions.

When it comes to defining the exact differences between episodic migraine and chronic migraine, two main issues come to mind. The two main issues are the type of pain experienced and the frequency of attacks. With certain patients experiencing them often enough in a short space of time for the condition to be defined as chronic.

Differences Between Episodic Migraine And Chronic Migraine

While chronic migraine seems to affect men and women equally, there are some aspects of chronic migraine that are not the same.  The following are the differences between chronic and episodic migraine.

  • Episodic migraineurs experience less than 15 headache days per month. Occasional sufferers – experience 15 or more headaches days per month. Chronic migraineurs – have headaches on 15 or more days per month for at least three months over the course of one year.
  • Chronic migraine patients who experience aura are more likely than those without aura to experience pain on both sides of their heads. While those without aura tend to have pain on one side.
  • Also, Chronic migraine is rare, and it used to be even more uncommon. However, recently study statistics show that there’s been a surge of more than 20%. It is caused by factors such as changing diets (more processed foods), chronic stress, overmedication, e.t.c.

Both types can use prevention and acute treatment to minimize symptoms.

Symptoms And Diagnosis of Episodic Migraines

People living with episodic migraine are diagnosed with the same condition as those living with chronic migraine. However, those living with chronic migraine will find it to be much more debilitating.

When it comes to diagnosing migraine, your physician is going to ask you a few basic questions that include; 

  • Where it hurts and what else happens.
  • Is there nausea with the headache? 
  • Do you vomit?
  • Does your face ache? 
  • Is your head hot or cold?
  • If you are always having headaches, you could have a headache disorder.

Symptoms can vary and often include:

  • The pain is a throbbing or pulsing pain
  • A change in the frequency or intensity of your headaches.
  • Change in the type of pain and what triggers your headaches.
  • Headache is accompanied by nausea and vomiting.

Note: Symptoms differ among individuals

Risk Factors for Progression from Episodic Migraine to Chronic Migraine

While episodic migraine (EM) is common, chronic migraine (CM) is not so common. In most cases, EM does not transform into CM. Nevertheless, some risk factors could lead to the transformation from episodic to chronic migraine.

  • Overuse of medications for relieving headaches is one of the important risk factors for progression to chronic headaches. Such overuse is caused by various reasons such as family history and so on.
  • Frequent headaches
  • Obesity
  • Low-income level 
  • Depression
  • Neck and head trauma

Additionally, if you have suffered rebound headaches before, you may be at risk for chronic migraine.

Managing Episodic Migraine

Sufferers from chronic migraines often have to deal with all sorts of symptoms that can interfere with their quality of life. For example, they often have spasms in several muscles at once and feel unusually tired and irritable.

The most important thing to get rid of chronic migraine is to know their risk factors and the transformation process. Understanding them will help prevent the development of chronic headaches.

Treatment Response

Patients and clinicians determine the optimal regimen for migraine treatment by considering the patient’s age, attack frequency, associated symptoms, tolerability of specific medications, presence of specific contraindications, and personal factors.

As with all medical problems, the recommended course of therapy is modified as needed to account for a patient’s progress in experiencing relief or adverse side effects.

The two major treatment responses are;

Acute Treatment

According to a recent study, non-steroidal anti-inflammatory drugs (NSAIDs) and triptans (serotonin 5HT1B/1D receptor agonists) are recommended as an acute treatment for migraine attacks.

NSAIDs such as ibuprofen and naproxen treat acute migraine attacks. They are one of the things you should avoid during your period too. They have a greater therapeutic effect than placebo in reducing pain and improving functional disability when given to migraineurs during an attack.

Triptans are generally effective for acute treatment of migraine, but they carry a significant risk for side effects or adverse events. Once relieved or improved, the drugs are discontinued.

Preventive Treatment

The purpose of preventive treatment is to provide relief from migraine attacks. This happens through the use of medications known as preventives.

This kind of therapy aims not to cure migraine, but rather to treat a person’s condition and prevent the attacks. As a treatment for migraine, preventive medicine could be an effective strategy to avoid the debilitating attacks of migraine. 


Lastly, people need to be aware that migraine is not life-threatening. Episodic migraine sufferers should never delay going to the emergency room. Seek medical attention immediately if you have frequent episodes of nausea and vomiting, feel faint, or doze off easily. Despite not having any other symptoms for weeks or months, that may indicate a very high risk for stroke. 

Furthermore, if you have a severe headache that feels like your head is exploding or need to vomit more than once.

Lastly, some people use over-the-counter drugs and experienced side effects. If you find yourself occasionally unable to move for several hours and then suddenly able to walk, consult a doctor.

Episodic Migraine FAQs 

What percentage of patients with episodic migraine will progress to chronic migraine?

Approximately 3 percent of people who have episodic migraine transform to chronic migraine each year. Most of those who become chronic probably had premonitory symptoms. The rest probably didn’t comply with their doctor’s treatment plan completely. This isn’t enough to rid them of their symptoms. Although a few people with episodic migraine do experience something like chronic migraine. It appears this condition is rare.

Can chronic migraines cause brain damage?

Chronic migraines might cause brain damage in some people. Chronic migraines can have larger health consequences than you expect. They can actually make you lose brain cells.

During a migraine attack, high levels of oxidative stress hormones can make small blood vessels leaky. Leaky blood vessels are a common cause of such brain lesions.

Can vitamin deficiency cause migraines?

Vitamin D deficiency is common in the US, and it can contribute to a variety of ailments. One of these ailments is migraine headaches. Nevertheless, the relationship between vitamin D deficiency and migraine headaches is not fully explored.

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