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Could your migraine pattern be changing quietly before you ever reach the number of headache
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days associated with chronic migraine?
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Welcome to Migraine Heroes, a podcast for people living with chronic migraines with
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years of pain, misunderstanding and lack of answers.
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I'm Diane Ducarme, I've helped more than a thousand people reduce the burden of migraines
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and feel more in control.
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My mission in life?
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To help a million people.
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Each episode brings you grounded insight into what your body might be asking for and what
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Just to keep you fully supported, this podcast is educational.
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For diagnosis or medication, always work with your doctor.
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Now take a breath and let's dive in.
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In this episode, you will learn how to spot the early, easily missed signs that your migraine
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pattern may be becoming more frequent, even before you reach the official threshold for
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Why mild headache days, longer recovery periods, increasing sensitivity and more frequent medication
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use may reveal far more about your migraine burden than the number of severe attacks alone.
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And how to track your pattern in a simple, meaningful way, so you can recognize what
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is changing, make more informed decisions and seek the right support before migraine
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takes up even more of your life.
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Stay with me till the end, because by the end of this episode, you will know exactly
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what to do and what not to do when you think your migraine is becoming chronic.
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Now before we talk about numbers and diagnostic criteria, I want to acknowledge how confusing
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this transition can feel.
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So perhaps your migraine attacks used to be clearly separated.
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An attack began, became intense, eventually passed and gave you several recognizable days
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Now the boundaries may feel less clear.
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So the severe attacks may not be dramatically worse, but headaches are appearing more often.
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And although pressure remains after the main pain fades, light still feels uncomfortable
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the following morning or you need longer time to recover.
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Your medication helps, but the relief does not last as long.
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You're cancelling more, resting more, and thinking about migraine more, even though
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you may still tell yourself, it's not bad enough to call this chronic.
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And this is how migraine progression can remain a bit hidden.
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It does not always announce itself with one dramatic change, sometimes it can.
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Sometimes it arrives as one extra headache day here, a slower recovery there, and fewer
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completely clear days in between.
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So what is the difference between episodic and chronic migraine?
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So there's a formal distinction that is based largely on frequency.
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And so here we're going to take international standards and we're going to take the international
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classification of headache disorders.
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And according to that classification, chronic migraine involves headache on at least 15
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days per month for more than three months.
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So on at least eight of those days, the headache must have migraine features, meet criteria
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for probable migraine, and be recognized as migraine, and respond to migraine-specific
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And episodic migraine generally means that headache occurs on fewer than 15 days per
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That sounds like a clear dividing line, but biologically and personally, the transition
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is often not that clear.
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So a person who moves from three headache days to nine headache days per month has not
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crossed the official chronic migraine threshold, yet their life may have changed enormously.
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Someone with 13 headache days may be experiencing almost the same level of uncertainty medication
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use or disruption than someone with 15.
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So the number 15 is important for diagnosis and research, but it's not a magical point
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at which migraine suddenly becomes serious.
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Progression can begin long before the label changes.
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So what I would like to do today is to walk you through eight quiet signs that your migraine
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is becoming more chronic.
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So quiet sign number one, your total headache days are increasing.
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So the first quiet sign is almost the most important.
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You're having more days with any kind of headache.
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People often count only the attacks that feel unmistakably like a migraine, but they record
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the days with throbbing pain, nausea, vomiting, aura, or urgent needs to lie in the darkness.
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But chronic migraine can include both migraine-like and tension-type-like headache days, a day
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with mild pressure, heaviness, or background pain may still need to be counted as a headache
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day, even when it does not resemble your most severe attacks.
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And this is something I've seen over and over again.
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When I ask people, I used to ask people, how many migraine days you have each month, which
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used to be the question we used to ask, would often minimize what was really happening.
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They have become so used to toughening out, pushing through, and pretending they're fine
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when they're not, that they stop counting many of the days on which migraine is still
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They may count only the most severe attacks, the days when they are forced to stop completely.
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They do not count the days when they worked through the pain, avoided the bright lights,
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struggled to concentrate, canceled an evening plan, or came home and collapsed.
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So they may say they have five migraine days a month, while migraine is actually shaping
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15 or 20 days of their life a month.
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And this is the heartbreaking part.
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Life may be even more difficult than they are able to describe because they have become
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so accustomed to functioning through symptoms that they no longer recognize just how much
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they are carrying.
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And so this is where the undercounting begins.
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You may tell yourself, oh, that was just a small headache.
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I could still work.
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I don't need my migraine medication today.
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Oh, it was probably tension.
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I disappeared after coffee.
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But if head pain was present, the day contains useful clinical information.
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That's why at Migraine Heroes, we track the bad days and the good days and everything
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So quiet sign number two, the pain-free windows are shrinking.
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So sometimes the number of attacks does not seem dramatically different, but the attacks
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begin taking up more space.
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The warning phase may start earlier.
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The pain may start longer.
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The post-attack exhaustion may continue into the next day.
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And before you have fully recovered, another attack begins.
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And you may still describe this as two or three attacks, but the total number of affected
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days may be much higher.
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So this creates what can feel like one long migraine landscape.
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With peaks of severe pain and valleys of milder symptoms, the complete clear days become just
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That loss of separation, it matters.
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When migraine becomes very frequent, individual attacks can become difficult to distinguish.
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Headache characteristics may also change from day to day or even within the same day.
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So this is one reason the International Headache Society recommends using a daily headache
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diary when frequent or chronic migraine is suspected.
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And so ours at Migraine Heroes is free of charge.
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Now, of course, there are more services with fees, but the peer tracking is free of charge.
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Now, I want you to pay attention when recovery is no longer returning you to your previous
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You may say, the pain is better, but I'm not really well.
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I can function, but everything feels harder.
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I'm waiting for my brain to come back.
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I cannot tell whether the last attack ended or if the next one started.
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And so these experiences do not prove that migraine has become chronic, but they are
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worth recording and observing.
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Now, quiet sign number three, your good days are no longer symptom-free.
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So a good day may still contain light sensitivity, sound sensitivity, neck discomfort, nausea,
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fatigue, dizziness, difficulty finding words, or a feeling that your brain is moving more
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slowly because the pain is not severe.
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You may not count that day, but the nervous system may not have returned to a fully settled
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So when people begin living in a nearly continuous state of vulnerability, they can work or complete
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household tasks, but only by controlling light, noise, movement, and social demands.
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They may stop attending evening events because the effort is too great.
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They may avoid exercise because exhaustion, because exertion feels risky.
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They may need sunglasses more often, lower the volume of the television, or feel overwhelmed
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in shops that were previously manageable.
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And this change in sensory tolerance can be a meaningful part of the pattern.
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Scientific models of migraine chronification frequently involve increased sensitivity within
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pain processing pathways, including the trigeminal vascular system.
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Researchers are studying how repeated activation, sensitization, and neuroimmune interactions
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may contribute to persistent migraine symptoms, although the complete process is still not
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So this does not mean that an occasional sensitive day proves your migraine is progressing.
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Are ordinary environments harder to tolerate than they were six months ago?
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Does stimulation affect you on more days?
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Do you need more recovery after normal activities?
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Your nervous system may be telling you that its available margin is becoming smaller.
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Quiet sign number four.
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Touch and movement are becoming more uncomfortable.
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So another possible sign of increased sensitization is allodynia.
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Allodynia means that something which is not normally painful begins to hurt or feel unpleasant.
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And during a migraine, this can include brushing your hair, wearing glasses, resting your head
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on a pillow, putting on a hat or touching your scalp, wearing earrings, allowing shower
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water to strike your skin.
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And so for some people, the discomfort extends beyond the head and face.
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Allodynia is common in migraine and has been associated with sensitization of pain processing
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And there was a clinical study that found that brush allodynia in more than 40% of chronic
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migraine patients studied.
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However, allodynia can occur in both episodic and chronic migraine.
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So this is not the diagnostic test you can perform on yourself.
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It's a signal to record.
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You might write hair brushing painful during attack or pillow uncomfortable after improved.
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Scalp sensitivity now occurring twice a week.
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These observations are far more useful to a clinician than simply saying, my migraines
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That's why in the Migraine Heroes app, we ask about so many different things.
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Not too many, hopefully, but so many things because they help see the bigger picture and
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they help see what needs to be corrected.
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Quiet sign number five, you're reaching for acute medication more often.
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I have this beautiful story of Marine.
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There's a podcast about her and she was saying, I would no longer get out of the house without
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medications in my bag.
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And more than that, she was saying, I would medicate in the bathroom at work, hidden from
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So that's what we're talking about.
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As attacks become more frequent, it's natural to use treatment more frequently.
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You're trying to work just like Marine.
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You're caring for people just like her as a mom.
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You're trying to stop the attack before it becomes disabling.
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There's no shame in wanting relief.
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She was feeling really shameful about this, but the number of medication days matter.
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Medication overuse headache can occur in someone with a pre-existing headache disorder
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who develops headache on at least 15 days per month while regularly overusing acute
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headache treatment for more than three months.
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And so the threshold is going to depend on the medication.
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For some drug classes, it's 10 or more days per month.
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For simple pain relievers, it's generally 15 or more days per month.
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So this is not about addiction.
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It's not about weakness or doing something irresponsible.
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It can develop because the migraine itself is becoming more frequent, creating a cycle
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in which more pain leads to more treatment days, and frequent treatment may contribute
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to additional headache.
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So the strongest evidence for migraine progression includes increased headache frequency, depression,
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and frequent use or overuse of acute medication.
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You should not stop prescribed medication suddenly or redesign your treatment plan by
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Instead, count days of use, not only the number of tablets.
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If you take medication three times on Monday, there's one medication day.
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If you use different acute treatments on different days, record them all.
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A quiet warning sign, maybe that you're beginning to organize the month around whether you can
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afford another treatment day.
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It's really interesting in the podcast of Jaya, you will hear her say how she was taking
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a pill and she was segmenting into different parts so that they would help her on several
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Really interesting in profile and story.
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Quiet sign number six, your treatment helps less completely.
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So perhaps your acute treatment still helps, but the result is changing.
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The medication takes longer to work.
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The pain returns a few hours later.
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The nausea improves, but the pressure remains.
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You need a second dose more often, or you begin treating earlier because you are afraid
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the attack will escape your control.
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So poorly optimized acute treatment has been identified as a possible risk factor for migraine
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This does not mean that inadequate treatment causes every case of chronic migraine.
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It means that when acute treatment is unreliable, incomplete or frequently needed, it's worth
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reviewing the overall plan rather than simply repeating the same strategy more often.
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And there may be many reasons why treatment feels less effective.
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Quiet sign number seven, disability is rising faster than the headache count.
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Migraine progression is not only about frequency.
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Ask what migraine is doing to your life.
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Are you missing more work?
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Are you declining invitation earlier because you're afraid of canceling later?
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Are household tasks accumulating?
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Are you using every good day to catch up?
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Are you recovering through the weekend instead of participating in it?
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Are you spending more time planning around your symptoms?
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So in 2025, there was a longitudinal study that we discussed earlier, and disability
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increased in many more people than the number who officially crossed into chronic migraine.
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So it suggests that the burden can worsen substantially before a person meets the traditional
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frequency threshold.
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You do not need to prove that every attack was severe.
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You need to show honestly how migraine is changing your available life.
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Now quiet sign number eight, sleep, mood or other pain problems are increasing.
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Migraine does not exist in isolation.
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Sleep disturbance, depression, anxiety and pain elsewhere in the body can overlap with
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migraine and may contribute to a more difficult clinical picture.
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A 2023 review by Lipton grouped possible progression risks into migraine characteristics, treatment
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related factors, other health conditions, lifestyle factors and demographic factors.
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And the review found meaningful evidence for associations involving sleep disturbance,
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selected psychiatric symptoms, other chronic pain, metabolic conditions, physical inactivity,
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smoking and frequent caffeine intake, among others.
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The authors also emphasized that more research is needed to determine which interventions
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directly prevent progression.
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So these are risk associations, not personal verdicts.
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Depression does not mean migraine is psychological.
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Poor sleep does not mean you caused your condition.
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Body weight, stress and physical activity should never be used as tools for shame.
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These factors may interact with biology, access to care, hormones, other illnesses, financial
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pressure and the nervous system's overall burden.
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The purpose of recognizing them is not to create another list of ways you have supposedly
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It is to identify areas where you may deserve more support.
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So these are the eight quiet signs migraine is becoming from episodic to more chronic.
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And so today is really about helping you understand how the expression of your migraine has evolved
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so that you can begin observing the pattern and ideally tracking it and changing and reversing
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Now I need to tell you something really important.
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When you're in pain, it is deeply tempting to throw many solutions at the migraine at
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To change your diet, add supplements, add to your routine, try new treatments and remove
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possible triggers all at once.
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But when several things change in parallel, it becomes almost impossible to know what
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is helping, what is doing nothing and what may be making the situation worse.
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A sensitive nervous system often benefits from small, gradual and predictable changes.
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So my advice is to choose one meaningful change at a time and observe it carefully.
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Also look at what was happening around the onset of your migraine or around the period
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when it became more frequent.
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Was it a change in contraception, a relationship shift, trauma, prolonged stress?
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Was there a disrupted sleep or another health issue?
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And all of that may not be purely coincidental.
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Put on your detective hat, go back through your own timeline and listen to the Migraine
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Heroes podcast episode connected to the theme you recognize and use, extract that science
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to investigate what your intuition may be already telling you.
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The Migraine Heroes podcast is really there for that reason.
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Your intuition is often, often pointing in the right direction and those podcasts bring
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the science together so you feel less random and a lot more conscious, equipped with facts
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that help trust your body again.
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I think understanding and trust are paramount in getting better from migraine.
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Now seek advice from qualified professionals and remember that you are the person who has
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to live with the consequences of every single decision.
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It's easy for someone else to dismiss a treatment that did not suit you.
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They are not the one carrying its effects in the body.
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Oh, it's just only you having the side effects.
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No, it's actually, you know, maybe not just you.
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And regardless if it's just you or someone else, you are the one having to live with
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So pause, reflect, investigate and then choose carefully.
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In my experience, people are very completely wrong about what changed around the time their
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health changed, even when they do not yet have the scientific language to explain it.
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That is one purpose of this podcast, again, to bring research into the conversation so
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you can test your intuition more thoughtfully.
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So before rushing toward the next solution, take a step back and ask what changed?
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What has my body been trying to tell me?
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And what is the smallest wise step I can take next?
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Remember, every small step you take moves you closer to freedom.
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You are powerful, you are resilient, and you're not alone.
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Keep rising, Migrant Hero.
