Answer #5 - Migraines initially begin as episodic which means they can occur episodically once a month, twice a month, three times a month at the beginning when they occur. However over a period of time there is a tendency in certain portions of the population for migraines to become chronic. And there may be several reasons for that but one of the reasons of concern is for migraines to become chronic as the result of medication overuse.

There is a percentage of patients that will tend to overuse medications and there is a group of medications that are of concern. These medications include over the counter medications which can include Ibuprofen, Tylenol, Tylenol with codeine; medications such as Aspirin, and perhaps medications such as Valium and Gravol; although these haven’t been shown for certain. Another group of medications however are the Triptans; Triptan medications which I mentioned like Imitrex, Maxalt, Zomig Relpax, all of the Triptans can be included in this group. And the tendency for patients because they get such relief initially with the Triptans from their migraines at the beginning is to start overusing these medications and they can get into these patterns of overuse without even recognizing that it’s an issue.

The migraines tend to become more frequent and as they start to treat their migraines they start to perhaps anticipate that their headaches are coming more frequently and they get into a pattern where their headaches become chronic. The clinical picture that this presents is that they have a chronic low grade headache on a daily basis, but in addition to that they have migraine headaches perhaps once or twice a week that is like their migraines used to be. In other words severe throbbing pain with associated nausea, vomiting, sensitivity to light, sound, smell, disabling headaches where they will treat them as they used to treat them with their Triptan. These headaches can be very disabling and then in between they are never headache free.

So perhaps they will treat their other headaches with Ibuprofen every single day, but then in addition to that they may treat their severe migraines with something like one of the Triptans two to three times a week. The headaches may be caused by chronic medication overuse, but they are still suffering from their migraines. And this becomes a real problem and perhaps something that can’t really be treated or resolved until they actually come off of their medications and that’s when their headaches may sometimes settle down.