Chronic Migraine is a complex neurological disease that includes symptoms such as sensitivity to light and sound, nausea and severe head pain. To be considered chronic, a person has to have 15 or more headache days per month.  While 36 million Americans experience migraine, only four million have been diagnosed as chronic.

  1. Prodrome – Up to 72 hours before an attack, a migraine patient may experience warning signs that an attack will occur. Severe exhaustion or hyperactivity, difficulty concentrating, food cravings, sleepiness, and neck pain can occur during this phase.
  2. Aura – Aura symptoms occur immediately before the head pain occurs. The most commonly known aura is a visual disturbance, which can involve a temporary blind spot, blurred vision, eye pain, tunnel vision, or seeing stars or zigzag lines.  This typically lasts for 20-60 minutes. Other types of aura warning signs may include vertigo, tinnitus (ringing in the ears) and even temporary paralysis on one side of the body.
  3. Headache – Pain during this phase is often described as throbbing, pulsating, or stabbing. Other symptoms experienced include nausea, sensitivity to light and sound, chills, fatigue, numbness, tingling, weakness, or sweating. The pain may be felt behind the eye, in the neck and shoulders, and in the temples.
  4. Postdrome -Occurs after the intense pain has subsided. One can feel sluggish, exhausted, depressed, and confused for hours or even days after the initial attack.

Vision disturbances, or aura, are considered a “warning sign” that a migraine is coming. The aura occurs in both eyes and may involve any or all of the following:

  • A temporary blind spot
  • Blurred vision
  • Eye pain
  • Seeing stars or zigzag lines
  • Tunnel vision

Other warning signs include yawning, difficulty concentrating, nausea, and trouble finding the right words.

Not every person with migraines has an aura. Those who do usually develop one about 10 – 15 minutes before the headache. However, an aura may occur just a few minutes to 24 hours beforehand. A headache may not always follow an aura.

Migraine headaches can be dull or severe. The pain may be felt behind the eye or in the back of the head and neck. For many patients, the headaches start on the same side each time. The headaches usually:

  • Feel throbbing, pounding, or pulsating
  • Are worse on one side of the head
  • Start as a dull ache and get worse within minutes to hours
  • Last 6 – 48 hours

Other symptoms that may occur with the headache include:

  • Chills
  • Increased urination
  • Fatigue
  • Loss of appetite
  • Nausea and vomiting
  • Numbness, tingling, or weakness
  • Problems concentrating, trouble finding words
  • Sensitivity to light or sound
  • Sweating

Symptoms may linger even after the migraine has gone away. Patients with migraine sometimes call this a migraine “hangover.” Symptoms can include:

  • Feeling mentally dull, like your thinking is not clear or sharp
  • Increased need for sleep
  • Neck pain
As there are no biological markers for migraine, a diagnosis is based on clinical history as well as the exclusion of other medical conditions. Keeping a migraine diary can help a doctor diagnose and treat the symptoms of migraine.
Causes and Risk Factors
Migraine can be hereditary and are more common in women; they tend to appear more frequently between the ages of 10 and 45. Medical experts believe that the brains of migraine patients are more susceptible to  sensory overload, which can  manifest into a migraine attack.   Some common migraine triggers include: certain foods (ex. chocolate, nuts, dairy products, onions, meats containing nitrates as well as foods containing monosodium glutamate-MSG), alcohol, stress, anxiety, certain odors or perfumes, loud noises or bright lights, caffeine, changes in hormone levels, change in weather patterns and sleep patterns, and smoking.  
Preventative Treatment Options

There is no cure for migraine disease … yet! The goal is to treat attacks right away and to prevent future attacks by avoiding triggers and making positive life changes. Your doctor may prescribe preventative medications taken on a daily basis to potentially stop migraine attacks.  Preventative Medications may include:  Antidepressants such as amitriptyline or venlafaxine, blood pressure medicines such as beta blockers (propranolol, metoprolol) or calcium channel blockers (verapamil), anti-seizure medicines such as valproic acid, gabapentin, and topiramate.  Botulinum toxin type A (Botox) injections may also help reduce chronic migraine attacks.

Four pharmaceutical companies are in various stages of FDA approval for medicines that would help prevent migraine attacks. This would be the very first drug specifically designed to prevent migraine. All formulations target the Calcitonin-Gene Related Peptide (known as CGRP) receptors in the brain. Scientists have discovered that levels of CGRP increase during migraine attacks. The CGRP monoclonal antibodies aim to regulate CGRP output and prevent attacks.The earliest these drugs will be available to consumers is late 2018.

Treating an Attack with Abortive Medications

Medications used at the onset of an attack are called abortives. Abortive medications should be taken at the first sign of a migraine attack.  Over-the-counter pain medications such as acetaminophen, ibuprofen, or aspirin are effective for a population of migraine patients, however frequent use can cause stomach irritation and even damage the liver.  


Prescription medications are used to abort an attack and include triptans, such as Imitrex, or ergotamines such as the DHE . Other abortives include anti-nausea medications such as zofran or phenergan, anti-inflammatory drugs such as ketorolac or NSAIDS and steroids. 

Non-Medicinal Options
Non-medicinal options include implantation of a neurostimulator, nerve decompression or nerve ablation surgeries, external stimulators such as the Cefaly, Gammacore or Spring TMS, ketamine infusions and medical marijuana.
Complementary Therapies

Many migraine patients seek complementary and alternative medicines (CAM)

  • Natural supplements such as feverfew, CoQ10, magnesium, herbal treatments, vitamins, and minerals can be discussed with your doctor.
  • Mind-body medicine –  meditation, yoga, acupuncture, tai chi, hypnotherapy, and biofeedback.
  • Manipulative and body-based practices –  chiropractic spinal manipulation, acupuncture, and massage therapy


  • Eastern medicine – Traditional Chinese medicine, Homeopathy, and Naturopathy.

All patients should check with their healthcare provider before starting any treatment or type of therapy.

Diet & Nutrition

Some of the most common foods, beverages, and additives that may be associated with headaches include:
Aged cheese, which includes tyramine. Tyramine is formed from the breakdown of protein as foods age. These cheeses can contain high amounts of tyramine; brie, gorgonzola, cheddar, muenster, feta, mozzarella, swiss, parmesan and other highly processed cheeses.

Alcohol: Red wine includes titrates and histamines that can induce a migraine attack. Darker liquors are often culprits as well. Many clear alcoholic beverages such as vodka, gin, and white rum can sometimes be tolerated. Overall, alcohol can lead to dehydration, a common trigger.

Processed Foods Containing Additives

  •  Hot dogs
  • Ham
  • Sausage
  • Bacon
  • Luncheon meats and deli-style meats
  • Pepperoni
  • Other cured or processed meat
  • MSG (monosodium glutamate). MSG is a food additive/flavor enhancer found in soy sauce, meat tenderizer, Asian foods, and a variety of packaged foods.

Additional Potential Food Triggers

  • Nuts and seeds
  • Beans such as fava, broad, garbanzo, lima, pinto
  • Chicken livers and other organ meats
  • Smoked or dried fish
  • Sourdough bread, fresh baked yeast goods (donuts, cakes, homemade breads, and rolls)
  • Certain fresh fruits, especially citrus fruits
  • Dried fruits (figs, raisins, dates)
  • Onions
  • Olives
  • Pickles
  • Avocados
  • Soups made from meat extracts or bouillon (not homemade broth)
  • Cultured dairy products, sour cream, buttermilk, yogurt
  • Chocolate
  • Caffeine found in chocolate and cocoa; beverages such as coffee, tea and colas; also found in certain medications
  • Aspartame and other artificial sweeteners
  • Food containing artificial dyes

What Are the Symptoms of Food Additive-Induced Headaches?
Most headache symptoms begin within 20-25 minutes after consuming food additives. They include:

  • Pressure in the chest
  • Tightening and pressure in the face
  • Burning sensation in the chest, neck, or shoulders
  • Facial flushing
  • Dizziness
  • Headache pain across the front or sides of the head
  • Abdominal discomfort

Talk to Your Doctor

For people who take monoamine oxidase (MAO) inhibitor medications to treat their headaches, it is especially important to avoid all foods containing tyramine, including aged cheeses, red wine, alcoholic beverages, and some processed meats, as these foods can trigger severe high blood pressure.

It can also be helpful to keep a food diary to pinpoint potential food triggers.


Migraine Groups

Alliance for Headache Disorders Advocacy: allianceforheadacheadvocacy.org

American Headache and Migraine Association (AHMA): ahma.memberclicks.net

American Headache Society: americanheadachesociety.org

American Interventional Headache Society: interventionalheadache.net

American Migraine Foundation: americanmigrainefoundation.org

Association of Migraine Disorders: migrainedisorders.org

Migraine Research Foundation: migraineresearchfoundation.org

National Headache Foundation: headaches.org

National Institute of Neurological Disorders and Stroke (NINDS) – Migraine Information: ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page

The National Migraine Association: migraines.org

World Headache Alliance: w-h-a.org

Migraine Support

Clusterbusters: clusterbusters.org

Headache and Migraine News: headacheandmigrainenews.com

Headache on the Hill: allianceforheadacheadvocacy.org/headache-on-the-hill

Healthline: healthline.com/health/migraine

Migraine.com: migraine.com

Migraine Again: migraineagain.com

Migraine Connect: migraineconnect.com  

Migraine World Summit: migraineworldsummit.com

My Migraine Connection: healthcentral.com/migraine

MyMigraineTeam: mymigraineteam.com

Miles for Migraine: milesformigraine.org

Positive Health Wellness: Migraine Causes, Symptoms, and Natural Rememedies

Practical Pain Management – Migraine Treatment

Runnin’ for Research: runnin4research.org

Migraine Blogs

Brainstorm: migrainebrainstorm.com

The Daily Headache: thedailyheadache.com

The Daily Migraine: thedailymigraine.com

The Gluten Free Chef Blog: theglutenfreechefblog.com

Golden Graine: goldengraine.com

Making of a Brave Man: instagram.com/makingofabraveman

Migraine Chick: migrainechickie.blogspot.com

My Broken Brain: facebook.com/groups/384285098435674

Chronic Migraine Awareness: facebook.com/ChronicMigraineAwareness

Headache Tracking Tools, Online Diaries and Assessments

BonTriage: bontriage.com

Curelator: curelator.com

iHeadache: iheadache.com

Miggy: migrainevibe.com

Migraine Buddy: migrainebuddy.com

Migraine Meter: migraine.com/migraine-meter

Migraine Pal: migrainepal.com

MigrainePro: migrainepro.com

Patients Like Me: patientslikeme.com

Pediatric Resources

Migraine 4 Kids: migraine4kids.org.uk

Miles for Migraine Youth Camps: milesformigraine.org/youth-camps

Children’s Hospital of Philadelphia (CHOP) Pediatric Headache Program: chop.edu/centers-programs/pediatric-headache-program

Cleveland Clinic Pediatric Headaches: my.clevelandclinic.org/health/articles/pediatric-headaches

Disclaimer: The educational information provided is not a substitute for medical advice.  Always consult your primary care physician for diagnosis, treatment, and individual guidelines.