Chronic Migraine — ICHD-3 Diagnosis and Diary-Based Management

How chronic migraine is recognized

Diagnosis rests on history and diary, not scans alone. Key elements are frequency, migrainous features (throbbing, photophobia, nausea, aggravation by activity), and contributors such as sleep, menstrual cycle and acute-medication days. Reassuringly, most chronic migraine has no dangerous structural cause — the diary reveals the pattern.

• Headache on ≥15 days/month, migrainous on ≥8 days, for >3 months
• Nausea, photophobia or worsening with activity points toward migraine biology
• Acute-medication days ≥10–15 (triptan/combination) suggests medication-overuse contributor
• Sudden thunderclap, fever+neck stiffness or new focal deficit are red flags — urgent care

Management principles at the clinic

After ICHD-3 classification and diary review, Dr. Jitendra discusses preventive options, acute-use stewardship, lifestyle regularity (sleep, hydration, caffeine), and follow-up timing. No outcome is guaranteed; the emphasis is on measurement, education and continuity with the same neurologist.

• Diary for 4–8 weeks before escalation decisions
• Review all analgesics, caffeine and triptans — not just prescribed drugs
• Treat comorbidity (anxiety, insomnia, neck pain) that perpetuates frequency
• Plan follow-up with the same consultant to track days/month trend

Guidelines referenced:

• ICHD-3 (International Classification of Headache Disorders, 3rd edition)
• American Academy of Neurology — preventive migraine guideline
• WHO neurological disorders: public health challenges