What Are High-Frequency Episodic Migraines?

Medically Reviewed by Melinda Ratini, MS, DO on April 12, 2024
6 min read

Migraine is a neurological disorder in which you get recurring severe headaches. Some people also get bouts of nausea, weakness, and sound and light sensitivity. The intensity and frequency of migraine attacks can vary from person to person and can worsen over time.

There are mainly two categories of migraine: episodic and chronic. The difference between the two is the frequency and intensity of the attacks:

  • Episodic migraines happen between one to 14 times per month.
  • Chronic migraines happen 15 or more days per month over a period of 3 months.

Typically, chronic migraine is more severe and harder to treat.

Episodic migraine is more common, but it’s further split into two types. If you get migraine attacks less than 10 times per month, you may have what’s called low-frequency episodic migraine (LFEM). This is the most common type. If you get migraine attacks anywhere between 10 to 14 times a month, your doctor may call this high-frequency episodic migraine (HFEM).

Migraine is common and affects about 12% of Americans. But a migraine is more than just a bad headache. It can be quite debilitating, and the throbbing pain can disrupt your day-to-day life. According to the World Health Organization, it’s the sixth most disabling condition in the world.

Several risk factors increase your likelihood of migraine. Women are three times more likely to have them than men. It’s also more common for women between the ages of 15 and 55. Certain hormonal changes can trigger migraines.

Other factors include:

  • Family history of migraine -- about 80% of people with migraine have a close relative who also has it
  • Smoking
  • High stress levels

Certain medical conditions can up the frequency and intensity of your migraine attacks. They include:

  • Head or neck injury
  • Certain pain disorders
  • Obesity
  • Asthma
  • Snoring

Medication overuse, including migraine-treating drugs you may take, can increase your risk of HFEM or chronic migraine. It’s best to keep a close track of all the prescription and over-the-counter medications you take. If you start to notice an uptick in migraine frequency, let your doctor know. They may suggest a different medication to curb any possible progression or worsening of your migraine attacks.

The exact cause for migraine in general is complicated and doctors don’t fully understand it. Headaches usually occur when specific nerves in your blood vessels send pain signals to your brain. This causes inflammatory substances to enter your nerves and blood vessels, which in turn triggers a migraine attack. It’s unclear what provokes your nerves to do that.

In the case of HFEM, several different triggers could increase the frequency and intensity of your migraine attacks.

These include:

  • Anxiety
  • Hormonal changes in women
  • Bright or flashing lights
  • Loud noises
  • Strong smells
  • Medicines
  • Too much or not enough sleep
  • Sudden changes in weather or environment
  • Too much physical activity or exercise
  • Tobacco
  • Caffeine or caffeine withdrawal
  • Skipped meals
  • Medication overuse
  • Food allergies

In order to diagnose migraine, your doctor will do a thorough medical exam and take a detailed medical history including asking about your migraine-related symptoms, headache history, and your family’s migraine or headache-related history.

If you have migraine, finding out which type can help determine what kind of treatment plan will suit your needs best. To zero in on whether it’s LFEM or HFEM, your doctor may ask questions like:

  • How many migraines do you get in a month?
  • How severe and frequent are they?
  • If you have periods, did you get yours around the time you had the migraines?
  • Describe the type and location of the headache -- is the pain pounding, pulsing, or throbbing?
  • How long do the migraines last?
  • Are there specific activities, foods, stressors, or situations that trigger your migraines?
  • What medications do you take for pain relief? Do they work?
  • How often do you take medications?
  • Describe how you felt before, during, and after the migraine.

If you get less than 10 migraine attacks per month, your doctor will diagnose you with LFEM. If it’s between 10 to 14 per month, then it’s HFEM. You doctor may also order blood work and imaging tests like an MRI and a CT scan to rule out other causes for your pain besides migraine.

Your doctor may suggest keeping a migraine journal to write down details of the times, dates, and symptoms before, during, and after an attack. This can help your doctor give you an accurate diagnosis.

If you’ve been diagnosed with HFEM, it can take a significant toll on your overall quality of life. If you have HFEM, the intensity of the pain can vary and can cause mild to severe disability.

This can affect things like:

  • Going to school
  • Productivity at work
  • Household duties
  • Social life
  • Relationships with friends and family
  • Emotional and physical well-being
  • Earning potential

One European migraine study that looked at 8,271 people found that about 17.7% of men and 28% of women with migraine lost more than 10 days of activity due to debilitating pain.

If you have HFEM, you’re also at a higher risk of your attacks progressing to chronic migraine. Experts note that people with HFEM transition to chronic migraine at a rate of 2.5% each year. This can further affect your quality of life. To avoid progressing to chronic migraine, talk to your doctor about treatment options.

If you’re unable to get by day to day due to frequent migraine attacks, talk to your doctor as soon as possible. To assess the severity of your episodic migraine, your doctor may ask you to fill out the Migraine Disability Assessment (MIDAS) questionnaire.

The survey consists of several questions about your migraine attacks over the last 3 months. If your score is 6 or higher, your doctor may discuss an appropriate treatment plan to help you manage your symptoms.

There’s no cure for migraine. But certain prescription and over-the-counter drugs can help you manage your symptoms and keep the condition under control.

If your HFEM pain is mild to moderate, over-the-counter (OTC) pain-relieving drugs can help you manage it when necessary. The main ingredients to look for to relieve migraine pain are:

Be aware of how often you use OTC drugs. Medication overuse can cause rebound headaches. If you’re using OTC medication more than two times a week, tell your doctor about it. They may be able to suggest more effective options.

Several classes of prescription drugs can relieve severe migraine attacks or help you manage symptoms and improve your quality of life.

These include:

One 2021 study looked at galcanezumab versus a placebo drug to minimize pain for 1,773 people with HFEM. The study was done over 6 months. The researchers found that people who received galcanezumab shifted to either LFEM or had a very low frequency of migraine days (less than 3 migraine days per month) compared to the people who received a placebo. Those who had a reduction in the number of migraine days per month also saw an improvement in their quality of life.

If you’re having frequent migraine attacks or if they're getting worse, tell your doctor as soon as possible. They can help you find the right treatment plan to best manage your symptoms and quality of life.