Chronic migraine treatment Breaking the cycle of headache days

Living with migraine on most days of the month is exhausting, and it is easy to fall into treating one headache after another. Chronic migraine treatment works differently: the goal is to lower the number of headache days so attacks become rarer and easier to treat. Our Botox for migraines page covers the injections in detail. This post explains the whole plan they fit into.

What counts as chronic migraine?

Migraine becomes chronic when you have headaches on 15 or more days a month for more than three months, with migraine features, such as throbbing pain, sensitivity to light or sound, or nausea, on at least eight of those days. Many people with chronic migraine started with occasional attacks that became more frequent over time.

Why headache days add up

• Medication overuse: taking pain relievers or migraine rescue medicines on many days a month can itself cause more frequent headaches
• Sleep: too little, too much or irregular sleep is a common trigger
• Skipped meals and dehydration
• Caffeine: both too much and sudden withdrawal
• Stress and the letdown after it
• Hormonal changes in some women
• Neck and shoulder muscle tension, which can feed headaches that start at the base of the skull

Chronic migraine treatment options

A headache diary

Record each headache day, how bad it was, what you took and anything that may have set it off. After a month or two, patterns appear, and the diary shows your physician whether a treatment is working. Bring it to every visit.

Daily habits

Regular sleep and wake times, regular meals, enough water, steady caffeine intake and regular aerobic exercise lower headache frequency for many people. They sound simple, but they are the foundation the other treatments build on.

Preventive medicines

Taken every day or by monthly or quarterly injection, preventive medicines lower how often attacks happen. Several kinds are used, and your doctor matches the choice to your health and other conditions. They usually need two to three months at the right dose to judge.

Botox for chronic migraine

OnabotulinumtoxinA (Botox) is approved for adults with chronic migraine. A physician gives a series of small injections at set points across the forehead, temples, back of the head, neck and shoulders. The visit takes about 20 minutes and is usually repeated every 12 weeks. The first video shows injections across the forehead and at the back of the head and neck, the second shows injections in the forehead and scalp, and the third shows injections at the back of the head. The effect tends to build over the first two treatment cycles, so the plan is usually reviewed after about six months using your headache diary.

When neck pain is part of the problem

Some people’s headaches start in the neck or are made worse by tight neck and shoulder muscles. In that case, treating the neck can help: posture and strengthening work with physical therapy (offered in Brooklyn and Staten Island), stretches for neck pain, and sometimes trigger point injections for tender muscle knots. See our neck pain page and our guide to chronic neck pain treatment.

When a headache is an emergency

Call 911 or go to an emergency room for a sudden, severe “worst ever” headache, a headache with weakness, numbness, confusion, trouble speaking or vision loss, a headache with fever and a stiff neck, or a headache after a head injury. A new headache pattern after age 50 should be checked promptly.

Related care at Precision Care Medical & Sports Performance

Migraine treatment near you

Precision Care Medical & Sports Performance lists Botox for chronic migraine at all three offices. Call to confirm which location offers it on the day you need, and bring your headache diary to the first visit. Our pain management physicians see patients in Brooklyn, where Ashley Marcus, MD practices at our Brooklyn pain management office on Shell Rd, convenient to Brighton Beach, Bensonhurst and Midwood, so if you have searched for Botox for headaches in Brooklyn, start there. On Staten Island, Jake Stephen, DO sees patients for pain management on Staten Island, close to Dongan Hills, New Dorp and Great Kills.

If you are looking for a migraine doctor in Midtown East, Yuri Gordin, MD sees patients at the Precision Care Spine & Pain Center in Midtown Manhattan, 150 E 55th St, reached easily from Washington Heights, Spanish Harlem, Harlem and the Upper East Side. Pain procedures are performed at all three offices, and your physician explains where and when yours will be scheduled. Looking for migraine treatment near me? Request an appointment or call the office closest to you.

Questions patients ask

Educational only, not medical advice. These videos and this article explain common problems and treatments in general terms. They are not a diagnosis or a treatment plan for you. Results vary from person to person. See a qualified clinician about your own symptoms, and call 911 or go to an emergency room for an emergency.

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