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Chronic Migraine - paper by Dr Silver


Another paper by Dr Nicholas Silver courtesy of Hannah on CHRONIC migraine. This is very good indeed because we so rarely here this term used in a way that suggests we can feel this stuff 24/7. Who relates to this?

— Begin quote from ____

"Although headaches are often the most prominent feature of chronic migraine, some people experience relatively little discomfort. Some patients with chronic migraine present with other predominant complaints:

chronic fatigue
neck or back pain
generalised body pains and tenderness
poor memory and forgetfulness
excess sensitivity to noise or light
numbness down one side of the face or body
neck pain
exacerbation of irritable bowel symptoms

In such people, it is important to recognise that features of chronic migraine are also present and that vigorous and appropriate treatment of this condition may provide significant alleviation of these symptoms.

Certain factors may trigger a change from acute or chronic migraine and include hormonal changes, viral illness, stress, head injury etc. Often we can not identify a particular cause in individual cases. However, despite the initial trigger, it is most commonly the intake of painkillers and other acute attack medications(1) and/or caffeine (2) that keep it going. Even very small amounts may stop people getting better.

Successful management of chronic migraine involves laying down a good “foundation” of lifestyle. In other words, there is relatively little point treating with a migraine preventative drug if one has not done the basics. Like any foundation, it needs to be left in place long term!
The foundation of good management is:

No painkillers / acute attack medication
No caffeine
Good hydration
Regular meals
Regular sleep

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Hey Scott as you already know via our chats,
I do have many and more symptoms mentioned on this article.
They plague my every day life.
The brain fog, fatigue, memory issues, persistant rocking vertigo, visual movement/shifting, speech problems/slurring like a drunk, studdering and painful muscles play a big part in making my life a misery.
It’s a relief to hear from someone in the know, that all this hasn’t been just craziness.
I’d just like to not have 3 or more hours out of my day stolen from me, and to have the normal brain capacity that other people have.


Hey Jen,

I also have some of the daily symptoms that Scott mentioned…but i also have a constant Motion 24/7 (i’m moving, not my surrounding) and feels like my brain or something inside my head is being Squeezed. These two symptoms are most bothersome now after 18 years of this condition. A small amount of medication helps to minimize the symptoms and keeps me in a relatively manageable mood. Many Years back Vertigo was at the top of the list of bothersome symptoms.


The “good hydration” bit may be what I ignore at my greatest peril. I realized that on “bad days,” I’ve dissociated a bit while swimming (hard), in that I don’t remember ending my swim. There’s a good chance that the exercise was causing dehydration.

This is a current link to this paper with actually deals specifically with chronic migraine and it’s treatment. I suspect this paper may well be a prequel to the much longer Comprehensive Migraine Guide I’ve linked previously and originating from the Walton Centre.

I printed this off for reference years ago and long thought it lost off the internet so was delighted to rediscover it recently. I’d consider it a concise introduction initially maybe better for newcomers than the later Walton Centre document.

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