Chronic migraines are more than “just bad headaches.” Affecting millions globally, they can cause relentless pain, nausea and fatigue that disrupt daily life.
According to the World Health Organisation, headache disorders, such as migraines, tension- or cluster headaches, affect approximately 40% of the world’s population.
Dr Alison Richardson, neurologist at Mediclinic Cape Town, explains that chronic migraine is defined as having a headache on 15 or more days a month for at least three consecutive months.
“It’s not just about having a frequent headache; it can be a complex, long-term condition that can completely take over your life.”
The head and brain remain remarkably complex. Researchers continue to discover more about how brain chemistry and a range of external factors may interact with one another and how these may relate to headaches and migraines. While the latter is already one of the most common neurological disorders globally, Richardson says chronic migraines are a more severe progression of the disease.
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What causes headaches or migraines?
So, what causes severe headaches or migraines? She says there is a strong genetic component. “Around half your risk comes from your genes, but environmental factors like stress, disrupted sleep, hormonal changes, diet and even the weather can play a role, too.”
With over 12 million South Africans likely to experience a migraine at some point, Richardson warns that chronic migraines may be significantly underdiagnosed. Symptoms often mirror typical migraines but occur far more frequently. These include:
- Pulsating, often one-sided head pain
- Nausea, vomiting and dizziness
- Sensitivity to light, sound and even smells
- Visual disturbances like zigzags or flashing lights
- Tingling sensations, neck stiffness, and mental fog
“For some people, it can feel like you’re living in survival mode,” she says. “The sheer frequency of attacks leads to lost productivity, social withdrawal, and even depression or anxiety.”
What can help?
Richardson says there is plenty that can be done to manage the condition and reduce the number of migraine days. Acute treatments are used to stop an attack once it begins. These include over-the-counter painkillers, migraine-specific medications and anti-nausea medications. Non-drug strategies, such as resting in a dark, quiet room and applying cold packs, can also be effective.
Preventing attacks from happening in the first place is the long-term goal. This can include using beta-blockers, antidepressants, anti-seizure medications, Botox injections and newer injectable drugs that target key migraine pathways. Non-drug options like magnesium, coenzymes, stress management, exercise and proper sleep habits can also make a world of difference.
In severe cases, especially when attacks last for days or come with severe dehydration, she says patients may need IV fluids, nerve blockers or other hospital-based treatments.
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When is it time to see a doctor?
Richardson warns that people often wait too long to seek help. If you’re having 15 or more headache days a month, or your attacks are getting worse, she says it’s time to see a specialist.
“This is even more crucial if you experience ‘red flag’ symptoms like sudden thunderclap headaches, changes in vision, or other neurological concerns.”
Relying too heavily on over-the-counter medication can make things worse. “One of the biggest risks is a medication overuse headache. Essentially, the more you take, the more headaches you get. That’s why early intervention is so important,” advises Richardson.
Chronic migraines don’t have a cure, but they can be managed. “With the right treatment, many patients see a significant drop in the number of headache days they experience.”
Mediclinic facilities offer treatment options, along with access to neurologists who specialise in migraine care. “We take a comprehensive approach to helping patients get back to living their lives,” says Richardson. “This includes medication, lifestyle strategies and specialist care.”
Her top advice for people suffering from chronic migraines? “Don’t suffer in silence. Chronic migraines are real and manageable, but you don’t have to fight them alone.”
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