Chronic migraine can cause headache on many days of the month, often with nausea, light sensitivity, sound sensitivity, dizziness, neck pain, facial pain, autonomic symptoms, or significant disruption to daily life.
Chronic migraines can disrupt every aspect of daily life. Dr. Siefferman explains how migraines are diagnosed and the personalized treatment options available to reduce their frequency, severity, and impact.
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Hi, I’m Dr. Jason Siefferman, medical director at Manhattan Pain Medicine and board certified headache specialist. Chronic migraine refers to migraines which occur 15 or more days per month and last more than 4 hours per episode. And of course, migraines include multiple symptoms, specifically light sensitivity, sound sensitivity, and nausea at least.
Now, when we see chronic migraine, we first want to understand is there something driving recurrent migraines. This can be a variety of triggers. People have multiple sensitivities. Sometimes there’s issues with the neck that trigger recurrent migraines. Sometimes it’s allergies. Sometimes sinus congestion. Sometimes mast cell activation syndrome. There’s a variety of issues that can be comorbid with chronic migraines such as depression or PTSD which we also want to identify and make sure that the patient is fully treated. We first want to fully understand everything going on that might be driving some of these migraines. Once we understand these things, getting the migraine under control is our priority.
Generally, we approach this by identifying, treating the triggers, but also by suppressing the tendency for the migraine to be triggered. So, raising the threshold for the migraine to be triggered. We do this with a variety of medications. Some of the newer CGRP medications are tremendously helpful. Botulinum toxin is tremendously helpful. And of course, there’s a number of older medications which are tried and true, which also help reduce the likelihood of triggering a migraine.
If someone is in status migrainosus, we also offer IV therapy, which can be an IV push of medication or a prolonged infusion just to break that cycle. Sometimes we’ll also use steroids to break that cycle. Whatever it is, know that if you have migraines that are not adequately treated, generally they’re fairly easy to get under control. We’re happy to help with that.
Chronic migraine is a high-frequency neurological pain condition that can affect daily function, work, sleep, concentration, movement, and quality of life. It is different from occasional migraine because headache occurs on many days of the month and often requires a more coordinated preventive treatment plan.
Chronic migraine is commonly defined as headache occurring on 15 or more days per month for more than three months, with migraine features on at least eight days per month. Migraine features may include throbbing or pulsing pain, nausea, vomiting, light sensitivity, sound sensitivity, aura, dizziness, neck discomfort, facial pain, or worsening with activity.
At Manhattan Pain Medicine (MPM), evaluation begins by confirming the headache pattern and identifying overlapping contributors. These may include autonomic dysfunction, POTS-like symptoms, cervical pain, TMJ dysfunction, dystonia, trigeminal nerve pain, EDS, hypermobility, MCAS, lupus, post-COVID symptoms, medication overuse, sleep disruption, stress physiology, or central sensitization.
For patients looking for chronic migraine treatment in Manhattan, MPM evaluates more than headache frequency alone. The assessment may include migraine symptoms, number of headache days per month, medication use, prior preventive therapies, response to Botox or CGRP medications, dizziness, nausea, light sensitivity, neck pain, jaw pain, facial pain, autonomic symptoms, post-COVID changes, inflammatory history, hypermobility, and prior imaging or specialist workup.
Care may include medication management, Botox for chronic migraine in appropriately selected patients, selected nerve blocks, trigger point injections, pain psychology, biofeedback, acupuncture, ketamine-related therapies when appropriate, and coordination with neurology, rheumatology, ENT, dentistry, ophthalmology, neurosurgery, primary care, or other specialists when needed.
MPM does not treat every migraine with procedures. Treatment depends on the headache diagnosis, frequency, medical history, medication pattern, prior response to care, safety considerations, and functional goals.
Chronic migraine can become difficult to manage when symptoms occur on most days, when acute medications are used frequently, or when the headache pattern overlaps with neck pain, jaw pain, autonomic symptoms, post-viral illness, inflammatory conditions, or chronic pain sensitization.
Some patients have migraine with dizziness, fatigue, rapid heart rate, nausea, light sensitivity, sound sensitivity, facial pain, or neck-related symptoms. Others have headache patterns that overlap with EDS, hypermobility spectrum disorder, POTS, MCAS, lupus, post-COVID pain, cervical dystonia, TMJ disorders, CCI, Chiari malformation, CSF outflow obstruction, or intracranial hypertension.
MPM’s diagnosis-first approach is designed to identify the dominant headache pattern, review medication use, screen for red flags, and determine which treatments or referrals are appropriate.
Chronic migraine is part of MPM’s Headache Zone of Expertise, with important overlap in Autonomic dysfunction when symptoms include dizziness, rapid heart rate, lightheadedness, nausea, fatigue, temperature sensitivity, GI symptoms, or POTS-like episodes.
For some patients, migraine is primarily driven by headache biology. For others, migraine may coexist with autonomic symptoms, hypermobility, neck pain, jaw pain, post-viral symptoms, inflammatory disease, or chronic pain sensitization.
MPM’s role is to clarify the pattern, identify treatable contributors, and coordinate care when chronic migraine is part of a broader multisystem presentation.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Chronic migraine is commonly defined as headache on 15 or more days per month for more than three months, with migraine features on at least eight days per month. Migraine features may include nausea, light sensitivity, sound sensitivity, throbbing or pulsing pain, aura, dizziness, or worsening with activity. Chronic migraine is different from occasional migraine because symptoms occur frequently and often require preventive care.
The main difference is frequency and treatment complexity. Episodic migraine occurs on fewer days per month, while chronic migraine involves headache on many days of the month. Chronic migraine can have a larger impact on daily life and may require medication review, preventive treatment, Botox consideration, evaluation for medication overuse, and assessment of overlapping conditions such as neck pain, TMJ symptoms, autonomic dysfunction, or central sensitization.
Chronic migraine can involve migraine biology, genetics, triggers, sleep disruption, hormones, stress physiology, medication overuse, autonomic dysfunction, cervical and jaw contributors, inflammatory conditions, post-viral symptoms, and pain sensitization. Many patients have more than one contributor, which is why careful evaluation is important before changing medication or adding procedures.
Yes. Chronic migraine can involve nausea, vomiting, dizziness, light sensitivity, sound sensitivity, visual symptoms, brain fog, fatigue, neck discomfort, and sensitivity to movement. Some patients also experience autonomic symptoms such as flushing, tearing, nasal congestion, lightheadedness, or rapid heart rate. These symptoms help guide the evaluation.
Autonomic dysfunction and POTS-like symptoms can coexist with migraine in some patients. Dizziness, lightheadedness, rapid heart rate, fatigue, nausea, GI symptoms, and temperature sensitivity may influence the overall clinical picture. MPM evaluates autonomic symptoms as part of the headache assessment and coordinates with cardiology, neurology, autonomic specialists, or primary care when appropriate.
In selected patients, EDS, hypermobility spectrum disorder, cervical instability concerns, Chiari malformation, CSF outflow obstruction, or intracranial pressure-related issues may overlap with headache symptoms. These conditions should not be assumed to explain every migraine, but they may influence evaluation when symptoms include neck pain, positional headache, dizziness, neurologic symptoms, or complex multisystem complaints.
Botox is used as a preventive treatment for appropriately selected patients with chronic migraine. It is generally considered for patients who meet chronic migraine criteria and have a clinical pattern that supports its use. Botox for chronic migraine is a medical treatment, not cosmetic Botox, and typically requires repeat treatments at scheduled intervals when effective.
Treatment may include medication management, preventive medications, CGRP-targeting therapies, Botox for chronic migraine, trigger management, sleep support, biofeedback, pain psychology, acupuncture, and selected procedures such as trigeminal nerve block or trigger point injections when the pain pattern supports them. Treatment should be individualized and supervised by a qualified clinician.
Nerve blocks may be considered for selected migraine, headache, or facial pain patterns. Depending on the symptoms, targeted approaches may include trigeminal nerve block, occipital nerve block, or other procedures. Nerve blocks are not appropriate for every migraine patient and should be based on diagnosis, pain location, prior response to care, and risk profile.
Headache symptoms require urgent evaluation when they are sudden and severe, the worst headache of the patient’s life, new after head injury, or associated with fever, stiff neck, confusion, fainting, seizure, weakness, numbness, trouble speaking, vision loss, pregnancy, cancer history, immune suppression, new headache later in life, or a major change in headache pattern.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If migraines are happening on many days of the month, interfering with your life, or not responding to standard treatment, MPM can help evaluate what may be contributing. Our diagnosis-first approach considers chronic migraine, medication overuse, neck and jaw contributors, autonomic dysfunction, POTS-like symptoms, hypermobility, post-COVID symptoms, inflammatory overlap, trigeminal nerve pain, and central sensitization. Request an appointment to discuss your symptoms and care options.
Chronic migraine is more than having “a lot of headaches.” It is a high-frequency neurological pain condition that can affect daily function, concentration, sleep, work, relationships, exercise, and quality of life. Many patients with chronic migraine experience headache on most days, with migraine features such as nausea, light sensitivity, sound sensitivity, dizziness, throbbing pain, aura, neck discomfort, facial pain, or worsening with activity.
Chronic migraine is commonly defined as headache on 15 or more days per month for more than three months, with migraine features on at least eight of those days. This definition matters because chronic migraine is often treated differently from occasional migraine. Patients may need preventive care, medication review, Botox consideration, evaluation for medication overuse, and a broader look at overlapping symptoms.
Migraine can become chronic for many reasons. Some patients have frequent attacks because of migraine biology, genetics, hormonal patterns, sleep disruption, stress physiology, triggers, or changes in routine. Others develop more frequent headaches after illness, injury, COVID infection, medication changes, or periods of increased pain and nervous system sensitivity.
Medication overuse can also contribute. When acute headache medications are used too often, the headache pattern may worsen or become more persistent. This does not mean the patient did anything wrong. It means the medication pattern needs to be reviewed carefully and adjusted under clinician supervision.
MPM evaluates headache frequency, medication use, prior treatment response, and overlapping conditions before recommending a plan.
Many migraine patients experience symptoms that involve the autonomic nervous system. These may include dizziness, lightheadedness, nausea, flushing, sweating changes, tearing, nasal congestion, rapid heart rate, temperature sensitivity, GI symptoms, or fatigue.
For some patients, these symptoms are part of the migraine pattern. For others, they may overlap with POTS, dysautonomia, post-COVID symptoms, MCAS-like symptoms, or another autonomic condition. MPM evaluates these symptoms in context and coordinates with cardiology, neurology, primary care, or autonomic specialists when needed.
Chronic migraine often overlaps with neck pain, jaw pain, muscle tension, or facial pain. Some patients have cervical muscle guarding, trigger points, cervical dystonia, TMJ dysfunction, bruxism, or orofacial dystonia that may contribute to headache intensity or frequency.
This does not mean every migraine comes from the neck or jaw. It means those areas should be evaluated when symptoms suggest overlap. MPM reviews the headache pattern, neck mobility, jaw symptoms, muscle tenderness, dystonia patterns, and nerve-related pain to determine whether targeted treatment may be appropriate.
Some patients with EDS or hypermobility spectrum disorder report migraine, neck pain, dizziness, jaw symptoms, fatigue, or positional head pressure. In selected cases, headache evaluation may need to consider craniocervical instability, Chiari malformation, CSF outflow obstruction, intracranial hypertension, or other structural or pressure-related concerns.
These conditions require careful review and appropriate specialty coordination. MPM does not assume that hypermobility causes chronic migraine, but it does consider whether connective tissue laxity, cervical mechanics, autonomic symptoms, or pain sensitization may be part of the patient’s overall presentation.
Some patients develop new or worsened migraine after COVID or another inflammatory or post-viral illness. Others have migraine flares in the setting of lupus, MCAS-like symptoms, autoimmune disease, or systemic inflammatory symptoms.
MPM evaluates whether the headache pattern appears consistent with chronic migraine alone, post-viral headache, inflammatory overlap, autonomic dysfunction, central sensitization, or another condition. Coordination with neurology, rheumatology, primary care, or other specialists may be needed when systemic symptoms are present.
Treatment for chronic migraine should be individualized. Options may include medication management, acute medication planning, preventive medications, CGRP-targeting therapies, Botox for chronic migraine, sleep and trigger management, biofeedback, pain psychology, acupuncture, and selected procedures when the pain pattern supports them.
Botox is used preventively for appropriately selected chronic migraine patients. It is not used for every headache type and should be considered only after confirming that the patient’s headache pattern and medical history support it.
Nerve blocks may be considered when headache or facial pain suggests involvement of a specific nerve pathway. Trigger point injections may be considered when muscle pain or myofascial pain contributes to the headache pattern. Ketamine therapy, lidocaine and ketamine infusions, and other infusion-based treatments should be considered only in selected patients and are not standard treatments for every chronic migraine presentation.
Pain psychology and biofeedback can be useful parts of care for some chronic migraine patients. These treatments do not suggest that migraine is imagined. They support nervous system regulation, coping, pacing, sleep, stress physiology, fear of symptoms, and function.
This can be especially helpful when chronic migraine overlaps with medical trauma, central sensitization, autonomic symptoms, anxiety around flares, or long-standing pain.
Some migraine patients need imaging or additional specialty evaluation, especially when headaches are new, changing, severe, unusual, neurologically complex, or associated with red flags. Neurology, ophthalmology, ENT, dentistry, rheumatology, neurosurgery, or primary care may be involved depending on the symptoms.
MPM coordinates care when chronic migraine overlaps with trigeminal neuralgia, cluster headache, TACs, TMJ disorders, cervical dystonia, CCI, Chiari malformation, CSF outflow obstruction, intracranial hypertension, lupus, MCAS, post-COVID symptoms, EDS, or other complex conditions.
Patients should seek urgent medical evaluation for sudden severe headache, the worst headache of their life, headache after head injury, fever, stiff neck, confusion, fainting, seizure, weakness, numbness, trouble speaking, vision loss, new neurologic symptoms, pregnancy with headache, cancer history, immune suppression, new headache later in life, or a major change in headache pattern.
These symptoms may reflect serious neurologic, vascular, infectious, inflammatory, or pressure-related conditions and should not be managed as routine migraine.
MPM approaches chronic migraine through a diagnosis-first, coordinated model. The goal is to confirm the headache pattern, identify overlapping contributors, evaluate medication use, screen for red flags, and build a plan that fits the patient’s symptoms and medical history.
For patients looking for chronic migraine treatment in Manhattan, MPM offers a careful pain medicine perspective that integrates headache care, autonomic dysfunction, neck and jaw contributors, trigeminal nerve pain, hypermobility, inflammatory overlap, post-COVID symptoms, psychology of pain, and complex chronic pain.
The goal is to clarify what is driving the chronic migraine pattern and guide appropriate next steps without overpromising outcomes.
