How Does Your Migraine Rank?

Written by Kelly Amspacher | December 10, 2021

I never dreamed that I would be ranking my migraine disease. Sports, yes… but migraine, not at all! I used to refer to my migraine days as ‘the good, the bad and the ugly.’ The good, low pain days were few and far between. As my ‘bad’ days increased to ‘ugly’ days, the ranking of my migraine followed. I moved from episodic migraine to chronic migraine to intractable chronic daily migraine. Each new ranking brought new anxiety, fear and desperation. Then I realized I am not alone. Of the approximately 40 million people in the US who have migraine, an estimated 4-6 million have chronic migraine.

What Is Chronic Migraine?

  • Chronic migraine is defined as 15 or more headache days per month, with at least 8 of those days being migraine, occurring for at least 3 months. (1)
  • Chronic migraine usually starts with episodic migraine which can progress over time due to several different factors, some of which may be controllable and some not.
  • According to the CaMEO (Chronic Migraine Epidemiology and Outcomes) study which looked at almost 13,000 patients with migraine, “over a 3-month period, 3.4% of patients with episodic migraine progressed to chronic migraine, while 49.9% of patients with chronic migraine improved to EM.” (2)
  • For individuals with episodic migraine, “the odds of developing CM increase with headache frequency by nearly 25-fold for those with the highest versus lowest headache frequency.” (3)
  • People with chronic migraine also often experience intractable migraine, or “status migrainosus.” This refers to a migraine attack that lasts more than 72 hours. It is a relentless, often seemingly untreatable migraine that frequently results in emergency room visits, or even inpatient treatment at times.
  • It generally takes a while for migraine to become chronic, usually months to years. The migraine attacks often start as low frequency episodic, then increase to high frequency episodic, and finally to chronic.

When to Seek Help

While it is possible to reverse the transition to chronic migraine, it is not something that tends to happen overnight unless a new and effective treatment is found. Rarely will the solution for chronic migraine be as simple as a new pill or a different device, although that is the case sometimes, especially with new genres of treatments being FDA approved. You can read about the standard treatment options in the Migraine Meanderings Migraine Treatment Toolbox.

If you’re running out of medications every month, counting or hoarding pills, or negotiating which migraine attacks are worth treating, you most likely are heading in a concerning direction and you should consider seeking care or changing to a certified headache specialist to get a second opinion.

Hope for Chronic Migraine?

In addition to medications and devices, part of the solution is to break down your migraine attacks into those things you can control versus those you can’t. Systematically work through the procedure of putting them in order, look at lifestyle changes you can make, consider alternative treatment options, and, as mentioned before, don’t be afraid to ask for a second opinion if necessary.

Most importantly, taking care of yourself may ease your chronic migraine attack frequency and intensity. Chronic migraine is a serious and often disabling condition, so:

  • Remember to rest when you need to rather than always pushing through.
  • Realize that it’s ok to say “no” to things that are likely to trigger bad attacks.
  • And reach out to people who understand when you need someone to talk to.

Let Us Know

So let us know… how does your migraine “rank” and do you have episodic or chronic migraine? If you are chronic, do you know how long it took for you to progress to that from your first migraine attacks? And finally, what are some of the things that help you?


  1. Weatherall, Mark W. “The Diagnosis and Treatment of Chronic Migraine.” Therapeutic Advances in Chronic Disease, SAGE Publications, May 2015,
  2. Ann, Scher, et al. “Pain Comorbidities of Episodic and Chronic Migraine: Results from the Cameo (Chronic Migraine Epidemiology & Outcomes) Study (P5.042).” Neurology, Wolters Kluwer Health, Inc. on Behalf of the American Academy of Neurology, 6 Apr. 2015,
  3. Moriarty, Maureen, and Theresa Mallick-Searle. “Diagnosis and Treatment for Chronic Migraine.” The Nurse Practitioner, Springhouse Corp, 19 June 2016,

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