What Causes Episodic Migraine to Become Chronic? 5 Modifiable Factors

Many of us currently living with chronic migraines know from first-hand experience what it’s like to go from infrequent, episodic migraines to the more frequent, unrelenting form of migraine disease known as a chronic migraine (aka transformed migraine).
Although preventive medications help some chronic migraine patients, are there risk factors we can identify that explain how or why this happens or help us reverse the course of migraine disease? Researchers are working to answer these questions. Here’s what we currently know.

An episodic migraine and chronic migraine are considered two different spectrums of the same disorder. The International Headache Society’s International Classification of Headache Disorders (ICHD-II revised), the Bible of headache disorders, treats a chronic migraine as a complication of an episodic migraine.

Patients experiencing episodic migraine have between 0 and 14 migraine attacks a month. Patients experiencing chronic migraine have more than 15 migraine attacks a month. (The ICHD-II revised attaches additional factors to the definition of Chronic Migraine.) Most migraine patients have the episodic version of the disorder. Those who have chronic migraines are significantly more disabled by migraine disease because their version dominates most aspects of their lives and has a greater impact on their quality of life.

While doctors and researchers can identify patterns among patients whose a migraine shift from episodic to chronic, it is hard to establish a cause and effect relationship between that process and any factor. This is one of the biggest problems in trying to identify risk factors for transformed migraine. Further, some of the factor researchers have identified are not modifiable.

Non-Modifiable Risk Factors include:

  • Age
  • Lack of education
  • Low socioeconomic status
  • Head injury


In contrast, familiarity with the modifiable factors associated with chronification can give patients and doctors some control. It allows us to direct our efforts at working on improving these factors whenever possible. But there are still limitations. Here are some cautions to consider:
  • Some patients will do their best to address as many factors as possible and still see limited improvement.
  • Some or all of the modifiable factors we think are causes may simply be correlations.
  • Certain modifiable factors are probably more significant than others.

We need more information about all of these factors and migraine disease itself. The important thing to keep in mind is that improving most of these factors can improve your overall health and quality of life, which is in itself a good reason to try to make changes.

Modifiable Risk Factors include:

  1. Obesity.
  2. Other lifestyle factors: caffeine, sleep apnea/snoring.
  3. Depression & anxiety.
  4. Central sensitization.
  5. Medication Overuse Headache (overuse of acute treatment medications for a migraine).


– Factors for Migraine Chronification: Obesity
– Factors for Migraine Chronification: Lifestyle Factors
– Factors for Migraine Chronification: Depression & Anxiety

– Factors for Migraine Chronification: Medication Overuse Headache
– Factors for Migraine Chronification: Central Sensitization

Questions or thoughts? Please share them in the comments.
1. Bigal, Marcelo E. and Lipton, Richard B. “Modifiable Risk Factors for Migraine Progression.” Headache2006; 46: 1334–1343. 2. Katsarava, Zaza; Buse, Dawn C.; Manack, Aubrey N.; and Lipton, Richard B.”Defining the Differences Between Episodic Migraine and Chronic Migraine.” Current Pain and Headache Reports 2012; 16(1): 86–92. 3. Lipton, Richard B., “Tracing transformation: chronic migraine classification, progression, and epidemiology.” Neurology 2009; 72: S3-7.


Content by Diana E. Lee.

DISCLAIMER: Nothing on this site constitutes medical or legal advice. I am a patient who is engaged and educated and enjoys sharing my experiences and news about migraines, pain and depression. Please consult your own health care providers for advice on your unique situation.