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Chronic migraine and medication overuse.

Hans Christoph Diener1, Paul Rizzoli2

  • 1Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Medical Faculty of the University Duisburg-Essen, Essen, Germany.

Handbook of Clinical Neurology
|December 3, 2023
PubMed
Summary

Chronic migraine affects 1-3% globally and is influenced by medication overuse. Treatments include preventive medications and CGRP monoclonal antibodies, which are effective for chronic migraine with or without medication overuse.

Keywords:
CGRP monoclonal antibodiesChronic migraineConvergence theoryMedication overuse headachePeriaqueductal gray

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Area of Science:

  • Neurology
  • Headache Medicine

Background:

  • Chronic migraine, recognized since the 17th century, remains a significant diagnostic challenge with substantial societal impact.
  • Affecting 1-3% worldwide, patients with chronic migraine often transition between episodic and chronic phases.
  • Pathogenesis theories are evolving, supported by recent neuroimaging and clinical findings.

Purpose of the Study:

  • To review the current understanding of chronic migraine, including its prevalence, pathogenesis, and management.
  • To highlight modifiable factors contributing to the progression of episodic migraine to chronic migraine.
  • To discuss established and emerging therapeutic strategies for chronic migraine.

Main Methods:

  • Literature review of chronic migraine prevalence, pathophysiology, and treatment options.
  • Analysis of factors contributing to migraine chronification, with a focus on medication overuse.
  • Evaluation of the efficacy of various preventive treatments, including CGRP monoclonal antibodies.

Main Results:

  • Medication overuse is identified as a key modifiable factor in the progression to chronic migraine.
  • Established preventive treatments include topiramate, valproate, and onabotulinumtoxinA.
  • CGRP monoclonal antibodies demonstrate efficacy in managing chronic migraine, irrespective of medication overuse status.

Conclusions:

  • Chronic migraine is a complex neurological disorder with significant global prevalence.
  • Addressing medication overuse is crucial for managing chronic migraine.
  • CGRP monoclonal antibodies represent a promising therapeutic advance for chronic migraine management.