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When Migraines Get Worse

Medically Reviewed by Hansa D. Bhargava, MD on November 09, 2020

Migraine often gets better over years, but that’s not always the case. Certain risk factors make you more likely to have it progress in some ways. Doctors and researchers have more to learn about how and why this happens. Here’s what they know so far.

When Migraines Happen More Often

One way migraine can get worse is when it becomes chronic. That means you have 15 or more headache days a month and have headaches with migraine symptoms on at least 8 of them, for more than 3 months. Every year, about 3% of people who had episodic migraines -- meaning they had migraines on fewer than 15 headache days a month -- shift into having chronic migraines.

One risk factor for this is the number of migraines you generally have. You may be more likely to have more if you’ve long had lots of headache days a month -- 10 to 14 for example. Another factor is if people in your family have migraine.

You and your doctor can work together to control other risks, such as:

Medication overuse or rebound headaches happen when you take pain relievers too often. The drugs can then start to cause headaches. This can develop if you have episodic migraines or chronic migraines. When you change how you use the meds, that cycle often stops. If you had episodic migraines that became chronic but were actually medication overuse headaches, treatment for those may help return you to episodic status.

Symptoms, Length, Intensity

Migraine is a condition that can change over time. So if yours become chronic, that doesn’t mean they’ll stay that way. Some people go back to fewer attacks.

The symptoms you have can also vary at certain points. For example, nausea and vomiting may not have been a problem before but are now a big part of your attacks. The overall intensity and length of your migraines may differ too.

People with migraine can also have a problem called allodynia. That is a skin sensitivity that makes everyday activities like hairstyling or a light touch on your body hurt or feel uncomfortable. If you have it, some pain medications won’t work for you. The risk of your episodic migraines becoming chronic also goes up. Allodynia is common with attacks, and 40% to 70% of people have it with one.

Perimenopause and Menopause

People in perimenopause (the time leading up to menopause) may especially notice that their attacks are worse. Experts believe this is because of the changes in estrogen levels that happen then.

But migraines tend to ease up once the transition to menopause is complete.

When to Talk to Your Doctor

No matter why your migraines get worse, these signs can tell you it’s time to get help:

  • Treatments that used to work don’t anymore.
  • You miss work, social, or family get-togethers.
  • You feel held back in your life by migraines.
  • You can’t do activities that were once easy.

Ask your regular doctor for help. They may recommend that you see a specialist like a neurologist who specializes in treating migraine and headaches.

WebMD Medical Reference

Sources

SOURCES:

Nada Hindiyeh, MD, clinical assistant professor of neurology, Stanford University.

Noah Rosen, MD, director, Northwell Headache Center;  associate professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY.

Headache: “Allodynia Is Associated With Initial and Sustained Response to Acute Migraine Treatment: Results from the American Migraine Prevalence and Prevention Study,” “Migraine Progression: A Systematic Review.”

American Migraine Foundation: “What to Know About Allodynia.”

Merck Manual: “Migraines.”

Mayo Clinic: “Medication overuse headaches,” “Migraine.”

Cleveland Clinic: “Chronic Migraine: Outlook / Prognosis,” “Chronic Migraine.”

Migraine Canada: “The Migraine Family: categories and groups.”

Menopause: “Evaluation and management of migraine in midlife women.”

NHS: “Overview-Migraine.”

American Headache Society: “Is Migraine a Progressive Disorder?”

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