Updates on chronic migraine treatment and management
Before deciding on chronic migraine management it is crucial to perform a proper patient evaluation. Most of the necessary information consists of simple questions. Nonetheless, many physicians advise baseline laboratory testing and MRI to exclude the secondary comorbidities. As such, treatment of chronic headache disorders depends on underlying etiology. It is important to begin patient consultation with the expectation that headache frequency and severity will decrease, but may not be completely eliminated. The patient should be also advised to decrease caffeine intake, control sleep schedule and use of analgesics. According to National Library of Medicine article, first-line pharmacologic treatment includes beta-blockers, anticonvulsants, and antidepressants. Among commonly prescribed medications are propranolol, topiramate, and amitriptyline. Second-line therapy includes Botulinum toxin A, approved by FDA. Most recent development in chronic migraine management is monoclonal antibodies that target calcitonin gene-related peptide (CGRP).