Update on treatment of chronic migraine

Chronic migraine is an underdiagnosed and undertreated subtype of migraine headache that affects 2% of general population. It is highly disabling and very burdensome for the individual and accompanied in many cases by psychiatric comorbidities. Through the process of migraine transformation, 3 percent of episodic migraine headache patients convert to chronic migraine with daily or near-daily headaches each year. The management of chronic migraine requires simultaneous pharmacological prophylactic therapy and non-pharmacological therapy and to avoid taking acute headache medication. Among currently available pharmacological prophylactic treatment options for chronic migraine, topiramate and onabotulinumtoxinA proved to be efficacious based on clinical evidence. Recently, calcitonin gene related peptide (CGRP) monoclonal antibodies demonstrated to be effective and well tolerated in phase II/II clinical trials and have received regulatory approval for prophylactic treatment of chronic migraine.Non-pharmacological treatment options for chronic migraine include: avoidance of migraine triggers, physical therapy and behavioral therapy including electromyography biofeedback, relaxation training, thermal biofeedback combined with relaxation training or cognitive-behavioral therapy. According to limited and inconsistent data neuro-stimulation techniques such as single-pulse transcranial magnetic stimulation, transcutaneous supraorbital nerve stimulation and occipital nerve stimulation might be beneficial for chronic migraine prevention. It is often necessary to use various modalities simultaneously for management of chronic migraine.

Keywords:

Chronic migraine , Chronic daily headache , Pharmacological treatment , Behavioral therapy , Neurostimulation