Coping with high-frequency episodic migraine

By Kerrie Smyres

Chronic and episodic migraine, two classifications of migraine disease, are often treated like two different entities, where the frequency of attacks suggests how much the disease affects a person’s life. But despite the commonly held belief that episodic migraine has a lesser impact, research shows that people with frequent episodic migraine attacks experience similar levels of disability and reduction in quality of life as people with chronic migraine.

High-frequency episodic migraine is defined as 10 to 14 headache days* per month. When compared to low-frequency episodic migraine (one to 9 headache days a month), researchers discovered in 2017 that the symptoms and disability of high-frequency episodic migraine looked a lot more like chronic migraine than it did low-frequency episodic migraine. In fact, outlining the results in the journal Cephalalgia, the researchers said, “The emotional and functional impact in high-frequency episodic patients could be as disabling as in those with chronic migraine.”
A 2018 study published in the journal Headache found that as the frequency of a person’s migraine attacks increased, no matter whether they were classified as chronic or episodic, their levels of disability, visits to the doctor, and costs of health care all increased.

Whether you are considered to have episodic or chronic migraine, as long as you feel like migraine is affecting your ability to live your life, your migraine attacks are too frequent. Maybe that’s one a day, one a week, or one a month. Whatever the frequency, if you feel burdened by migraine, then you should feel empowered to keep trying more treatment options.

One way to get better treatment is to change how you talk to your doctor about your migraine attacks. Instead of telling them the number of migraine attacks you have each month, count all days on which you have any migraine symptoms at all. If you have one day of feeling “off” before your attack begins, then a day of being significantly impaired by the attack, and another day of “migraine hangover,” each attack actually lasts three days. Knowing the number of days you are affected by migraine each month will influence the treatment options your doctor suggests for you, and possibly change the treatments your insurance will cover.

Episodic and chronic are useful distinctions for understanding migraine to an extent. But understanding how this disease can wreak havoc on a person’s quality of life requires thinking beyond two broad, binary categories. •

*While people with migraine usually talk about number of migraine days, researchers use the term “headache days.” For research, it is helpful to understand how often a person has head pain each month, whether or not it is clearly part of a migraine attack.

Kerrie Smyres is a writer and patient advocate who has had chronic migraine for 30+ years. She is the
founder of The Daily Headache and is a contributor. Kerrie is passionate about “translating” medical research into language patients can understand easily and writing candidly about life with chronic illness.