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Chronic migraine

Chronic migraine means headache on fifteen or more days a month for more than three months, with migraine features on at least eight of them. Assessment looks at what has driven the change from episodic to chronic — medication overuse, sleep, mood and neck contributors — and treatment addresses those alongside preventive options including injection-based treatment where criteria are met.

Chronic migraine is defined by frequency: headache on fifteen or more days a month for longer than three months, with the features of migraine on at least eight of those days. It is not simply migraine that happens often — the pattern changes. Headache becomes closer to a background state than a series of discrete attacks, acute medication stops working as reliably, and the days without pain become the exception.

How it develops

Most people with chronic migraine started with episodic migraine that gradually became more frequent over months or years. Several things drive that transformation: frequent use of acute headache medication, poor sleep, untreated neck pain, mood disorder, and periods of high stress. The process can run the other way too — chronic migraine can revert to an episodic pattern when the drivers are addressed, which is a large part of what treatment aims at.

Medication overuse comes first

Taking acute headache medication on more than about ten to fifteen days a month can itself sustain a daily headache, and no preventive treatment works reliably while that continues. Identifying it is not a criticism — it happens precisely because the medication works, and people use what works. But it has to be addressed, and doing so is often the single largest change available. This is planned with you and with your GP rather than imposed.

Assessment

The consultation establishes the pattern rather than a single diagnosis: how many headache days, how many have migraine features, what acute medication is being used and how often, which preventers have been tried and at what dose and for how long, and what else is contributing — sleep, mood, neck pain, jaw pain. A headache diary kept for four weeks before the appointment is the single most useful thing you can bring. Examination includes the neck, because neck structures contribute to a substantial proportion of persistent headache and are treatable in their own right. Where the picture suggests something other than migraine, further investigation or a neurology opinion is arranged.

Treatment

Management is layered rather than singular. Preventive medication is reviewed — often the issue is that a reasonable preventer was stopped too early or never reached an adequate dose. Where the neck is contributing, procedures directed at the occipital nerves or the upper cervical joints can reduce the headache burden. For people who continue to have frequent headache despite adequate trials of preventive medication, an injection-based preventive treatment is available: a set of small injections at fixed points across the forehead, temples, back of the head, neck and shoulders, repeated about every three months. Sleep, activity pacing and mood are addressed alongside, because they are drivers rather than consequences.

What to expect from the injection treatment

It is preventive, not a treatment for an attack in progress. Benefit builds over weeks rather than days, and response is assessed over two full cycles — roughly six months — before judging whether it is worth continuing. The realistic aim is a meaningful reduction in headache days and in the severity of the days that remain, not their abolition. Not everyone responds, and where two cycles produce nothing the treatment is stopped rather than continued out of momentum.

Eligibility and funding are separate questions. The diagnostic criteria for chronic migraine are not the same as the eligibility criteria for any subsidised treatment, and Medicare rebates, medicine subsidies and private insurance each have their own requirements. Whether a particular treatment is suitable for you, and what it will cost, are both confirmed in writing before anything proceeds.

Risks

Whilst pain procedures are generally safe and well tolerated, all procedures carry risks. The specific risks relevant to you and your procedure will be discussed with you, and written information provided, before you decide to proceed.

What this practice does and does not do

Ongoing prescribing of headache preventers generally stays with your GP or neurologist. The contribution here is a structured assessment of what is driving a headache that has become chronic, treatment of the neck component where one exists, injection-based preventive treatment where criteria are met, and a written plan that says plainly what should change and in what order. Not every person with chronic headache needs a procedure, and the consultation will say so where that is the case.

Referral

A referral is required. Referrals are accepted from GPs, neurologists and other specialists. Please include the headache frequency, the acute medications being used and how often, and the preventers already tried with doses and duration — that information determines what can be offered. Telehealth assessment and review are available for rural and remote patients.

Sources: International Classification of Headache Disorders (ICHD-3); Healthdirect Australia.

Common questions

What counts as chronic migraine?
Headache on fifteen or more days a month for more than three months, with migraine features on at least eight of those days. It usually develops gradually out of episodic migraine rather than starting that way.

Why do I need to bring a headache diary?
Because the diagnosis and the treatment options both depend on frequency — how many headache days, how many have migraine features, and how often acute medication is being used. Four weeks of simple daily records is more useful than any scan and is the single most valuable thing to bring to the appointment.

Can medication be making my headaches worse?
It can. Using acute headache medication on more than about ten to fifteen days a month can sustain a near-daily headache on its own, and preventive treatment rarely works while that continues. It happens because the medication works in the short term. Addressing it is planned with you and your GP, and is often the largest single improvement available.

What is the injection treatment for chronic migraine?
A preventive treatment given as a set of small injections at fixed points across the forehead, temples, back of the head, neck and shoulders, repeated about every three months. It is for people who still have frequent headache after adequate trials of preventive medication. It is not a treatment for an attack in progress.

How long before I know whether it is working?
Benefit builds over weeks, and response is judged over two full cycles — about six months. If two cycles produce no meaningful reduction in headache days, the treatment is stopped rather than continued indefinitely.

Are all treatments subsidised?
No. Medicare rebates, medicine subsidies and private insurance cover each have their own eligibility requirements, and the diagnostic criteria for chronic migraine are separate from any subsidy criteria. A written estimate and confirmation of the funding arrangements for your proposed care are provided before proceeding.

Will Dr Martin take over my migraine prescribing?
Generally no. Ongoing preventive prescribing usually stays with your GP or neurologist. The role here is structured assessment of what is driving the chronic pattern, treatment of any neck contribution, injection-based preventive treatment where criteria are met, and a clear written plan.

Do I need a referral?
Yes, from a GP or specialist, both to be seen and to claim a Medicare rebate. Please ask your doctor to include headache frequency, current acute medication use, and which preventers have been tried at what dose and for how long.