PONOS CLINIC · SPECIALIST PAIN CARE
Chronic migraine
Understand the frequency, reduce the impact, build a care pathway.
When headache occupies many days of the month, a precise assessment helps distinguish the factors involved and guide appropriate care.
Request an assessmentThe care pathway
When migraine becomes chronic
Chronic migraine is a neurological condition that can affect work, sleep, relationships and everyday activities. It does not simply mean particularly severe attacks: the frequency of headache over time is central to the diagnosis.
Frequency
Headache on at least 15 days a month for more than three months.
Features
At least eight days a month have migraine features, as defined by the ICHD-3 diagnostic criteria.
Impact
Assessment also considers disability, medication use and limitations in daily life.
Attacks may involve nausea, sensitivity to light and sound, and worsening with physical activity. In chronic migraine, intensity and symptoms can vary from day to day; not every headache day feels the same.
A precise diagnosis before choosing treatment
Diagnosis is clinical. The consultation reviews the evolution of attacks, associated symptoms, neurological examination and previous treatments. Investigations are requested when the history or examination indicates a need.
A headache diary helps record headache days, intensity, duration, medication and response. Bring relevant reports and a list of preventive treatments, including doses, duration and any adverse effects.
What can contribute to chronic migraine?
Frequent attacks, sleep disorders, stress, other health conditions and frequent acute medication use may contribute. Neck pain can accompany migraine: on its own, it does not establish an occipital neuropathy.
The PONOS specialist pathway
Understand the problem
Distinguish chronic migraine from other headaches and identify possible associated pain conditions.
Review prevention
Consider preventive options, including CGRP-targeted treatments and botulinum toxin when indicated, in coordination with the specialist managing your migraine.
Identify possible peripheral triggers
If occipital pain, symptom distribution and examination suggest a neuropathic component, investigate through targeted assessment and, where indicated, a diagnostic nerve block.
Measure the outcome
Compare headache days, intensity, medication use, sleep and the ability to carry out usual activities.
When might an occipital procedure be considered?
In selected patients with migraine and an occipital neuropathic trigger, treatment of the occipital nerves may be discussed. Symptoms, clinical examination and any response to an anaesthetic block need to be consistent. Radiofrequency is not a standard treatment for every migraine and does not replace neurological preventive care.
Explore the occipital nerve procedure · Treatment-resistant migraine
Frequently asked questions
Are chronic and resistant migraine the same?
No. Chronic describes frequency; resistant describes an insufficient response to adequate preventive treatments. They can coexist.
Is an MRI always needed?
No. The need for investigations depends on the examination, the course of the headache and any warning signs.
Does radiofrequency permanently eliminate migraine?
This cannot be promised. A procedure targets a selected pain component; the benefit and its duration vary and require follow-up.
Start with your clinical history
Bring your headache diary and details of previous treatments: they provide the starting point for an individual assessment.
Contact PONOS ClinicReferences
General information: this page does not replace a consultation or establish an indication for treatment on its own.