Intended for healthcare professionals

Clinical Review State of the Art

Chronic migraine

BMJ 2014; 348 doi: (Published 24 March 2014) Cite this as: BMJ 2014;348:g1416
  1. Todd J Schwedt, associate professor of neurology
  1. 1Mayo Clinic, Phoenix, AZ 85054, USA
  1. Correspondence to: T J Schwedt schwedt.todd{at}


Chronic migraine is a disabling neurologic condition that affects 2% of the general population. Patients with chronic migraine have headaches on at least 15 days a month, with at least eight days a month on which their headaches and associated symptoms meet diagnostic criteria for migraine. Chronic migraine places an enormous burden on patients owing to frequent headaches; hypersensitivity to visual, auditory, and olfactory stimuli; nausea; and vomiting. It also affects society through direct and indirect medical costs. Chronic migraine typically develops after a slow increase in headache frequency over months to years. Several factors are associated with an increased risk of transforming to chronic migraine. The diagnosis requires a carefully performed patient interview and neurologic examination, sometimes combined with additional diagnostic tests, to differentiate chronic migraine from secondary headache disorders and other primary chronic headaches of long duration. Treatment takes a multifaceted approach that may include risk factor modification, avoidance of migraine triggers, drug and non-drug based prophylaxis, and abortive migraine treatment, the frequency of which is limited to avoid drug overuse. This article provides an overview of current knowledge regarding chronic migraine, including epidemiology, risk factors for its development, pathophysiology, diagnosis, management, and guidelines. The future of chronic migraine treatment and research is also discussed.


  • Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following: in the past three years I have received personal compensation for consulting from Allergan, Levadex, Pfizer, Supernus, and Zogenix; I have received personal compensation for speaking from Allergan; and I have received research support from Merck.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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