Soo-Jin Cho1, Tae-Jin Song2, Min Kyung Chu3. 1. Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 445-907, Republic of Korea. 2. Department of Neurology, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 158-710, Republic of Korea. 3. Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea. chumk@hallym.ac.kr.
Abstract
PURPOSE OF REVIEW: Although chronic migraine (CM) is a common disorder that severely impacts patient functioning and quality of life, it is usually underdiagnosed, and treatment responses often remain poor even after diagnosis. In addition, effective treatment options are limited due to the rarity of randomized controlled trials (RCTs) involving patients with CM. In the present review, we discuss updated pharmacological, non-pharmacological, and neurostimulation treatment options for CM. RECENT FINDINGS: Pharmacological treatments include both acute and preventive measures. While acute treatment options are similar between CM and episodic migraine (EM), preventive treatment with topiramate and botulinum toxin A exhibited efficacy in more than two RCTs. In addition, several studies have revealed that behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation techniques are associated with significant improvements in symptoms. Thus, these treatment options are recommended for patients with CM, especially for refractory cases. Neurostimulation procedures, such as occipital stimulation, supraorbital transcutaneous stimulation, non-invasive vagal nerve stimulation, and transcranial direct current stimulation, have shown promising results in the treatment of CM. However, current studies on neurostimulation suffer from small sample size, no replication, or negative results. Although CM is less responsive to treatment compared to EM, recent advance in pharmacological, non-pharmacological, and neurostimulation treatments may provide more chance for successful treatment of CM.
PURPOSE OF REVIEW: Although chronic migraine (CM) is a common disorder that severely impacts patient functioning and quality of life, it is usually underdiagnosed, and treatment responses often remain poor even after diagnosis. In addition, effective treatment options are limited due to the rarity of randomized controlled trials (RCTs) involving patients with CM. In the present review, we discuss updated pharmacological, non-pharmacological, and neurostimulation treatment options for CM. RECENT FINDINGS: Pharmacological treatments include both acute and preventive measures. While acute treatment options are similar between CM and episodic migraine (EM), preventive treatment with topiramate and botulinum toxin A exhibited efficacy in more than two RCTs. In addition, several studies have revealed that behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation techniques are associated with significant improvements in symptoms. Thus, these treatment options are recommended for patients with CM, especially for refractory cases. Neurostimulation procedures, such as occipital stimulation, supraorbital transcutaneous stimulation, non-invasive vagal nerve stimulation, and transcranial direct current stimulation, have shown promising results in the treatment of CM. However, current studies on neurostimulation suffer from small sample size, no replication, or negative results. Although CM is less responsive to treatment compared to EM, recent advance in pharmacological, non-pharmacological, and neurostimulation treatments may provide more chance for successful treatment of CM.
Authors: Marcelo E Bigal; Rafael Escandon; Michele Bronson; Sarah Walter; Maria Sudworth; John P Huggins; Pamela Garzone Journal: Cephalalgia Date: 2013-12-23 Impact factor: 6.292
Authors: Donald B Penzien; Frank Andrasik; Brian M Freidenberg; Timothy T Houle; Alvin E Lake; Gay L Lipchik; Kenneth A Holroyd; Richard B Lipton; Douglas C McCrory; Justin M Nash; Robert A Nicholson; Scott W Powers; Jeanetta C Rains; David A Wittrock Journal: Headache Date: 2005-05 Impact factor: 5.887
Authors: J David Creswell; Adrienne A Taren; Emily K Lindsay; Carol M Greco; Peter J Gianaros; April Fairgrieve; Anna L Marsland; Kirk Warren Brown; Baldwin M Way; Rhonda K Rosen; Jennifer L Ferris Journal: Biol Psychiatry Date: 2016-01-29 Impact factor: 13.382
Authors: Jes Olesen; Hans-Christoph Diener; Ingo W Husstedt; Peter J Goadsby; David Hall; Ulrich Meier; Stephane Pollentier; Lynna M Lesko Journal: N Engl J Med Date: 2004-03-11 Impact factor: 91.245
Authors: Messoud Ashina; Stewart J Tepper; Jan Lewis Brandes; Uwe Reuter; Guy P Boudreau; Mark Weatherall; Andreas R Gantenbein; David Doležil; Jan Klatt; Andrea Wang; Ananda Krishna Karanam; Sunfa Cheng; Daniel D Mikol Journal: Headache Date: 2022-05 Impact factor: 5.311