| chronic pain

Ways to Manage Migraine

CGRP Antagonists, Neuromodulatory Devices, Guidelines

Chronic migraine is disabling, complex, and an expensive global burden; it has also been studied far less than episodic migraine. A review in BMJ focused on treatments, including calcitonin gene related peptide antagonists and neuromodulatory devices. Via keywords searches, including “chronic migraine treatment,” researchers gathered data from January 2012 to March 2022. Findings include:

  • Chronic migraine treatment goals = ↓frequency, ↓severity, ↑QoL
  • Abortive meds = ↑effective
  • Treatment should be patient specific and balanced between drug/nondrugs
  • Patients should be warned about expectations; those of childbearing age should be informed about medication effects on a fetus
  • Lifestyle modifications help

The study concluded, “New treatments…with the most robust evidence include onabotulinumtoxin A, erenumab, fremanezumab, galcanezumab, and eptinezumab. Moderate evidence for topiramate and recent evidence for rimegepant exist…”

“Most healthcare systems require that patients are treated using tiered therapies...despite the lack of data on efficacy in chronic migraine. Future research is needed...”

The good news is, “As new data on CGRP antagonists emerge...the landscape of chronic migraine treatment will continue to evolve. The combination of new treatments including neuromodulation, behavioral approaches, and other interventions such as nerve blocks has created a battery of options for patients.”

 

Read the journal article.

Holly Caster

Edit content

Sign-Up