Chronic migraine
Approximately 46% of the adult population has an active headache disorder. Of these, 11% have migraine, 42% have tension-type headaches and 3% have chronic daily headache.
Migraine affects about 15% of the UK population, is more common in females and tends to occur in people between their late teens and their 50s. It results in more than 100,000 school or work absences every day in the UK.

Migraine is diagnosed if a patient has at least five headaches fulfilling the following criteria:
Lasting 4–72 hours in adults
With at least two of the following characteristics:

Unilateral
Pulsating
Of moderate or severe intensity
Aggravated by, or causing avoidance of, routine activities such as walking or climbing stairs
Associated with nausea and/or vomiting and/or photophobia and/or phonophobia.

Chronic migraine is a headache of at least 15 days a month for more than three months and with the features of migraine on at least eight of the headache days.

Medication overuse headache is a headache occurring on at least 15 days a month developing as a result of regular overuse of headache medication, for more than 10 or 15 days a month (depending on the medication), for more than three months.

Patients with migraine should avoid excess caffeine and acute medication overuse, lose weight if obese, and aim to reduce stress.

UK recommendations for acute migraine treatments include oral triptans, NSAIDs, aspirin 900mg, paracetamol, a combination of an oral triptan and an NSAID or an oral triptan and paracetamol.
On the basis of RCT evidence, NICE -UK ,recommends a trial of topiramate or propranolol as first-line preventive treatment, or if these are unsuitable or ineffective, a course of 10 sessions of acupuncture over 5–8 weeks, or unlicensed gabapentin up to 1,200mg/day.
Migraine improves naturally with age with the frequency and impact varying over time.

G Mohan.