Chronic and Refractory Migraine: How to Diagnose and Treat

Authors

  • Elsa Parreira Consulta de Cefaleias. Hospital Prof. Doutor Fernando Fonseca. Amadora. Centro de Cefaleias. Hospital da Luz. Lisboa.
  • Isabel Luzeiro Consulta de Cefaleias. Centro Hospitalar Universitário de Coimbra. Coimbra. Departamento de Neurofisiologia. Escola Superior de Tecnologia da Saúde de Coimbra. Coimbra.
  • José Maria Pereira Monteiro Instituto de Biologia Molecular e Celular/Instituto de Investigação e Inovação em Saúde. Universidade do Porto. Porto.

DOI:

https://doi.org/10.20344/amp.12004

Keywords:

Headache Disorders, Secondary/chemically induced, Migraine Disorders/diagnosis, Migraine Disorders/drug therapy

Abstract

Migraine is highly prevalent and carries a significant personal, social and economic burden. It is the second cause of disability (years living with disability) worldwide and the first cause under 50 years of age. Chronic migraine (occurring for more than 15 days a month) and refractory migraine (treatment resistant), especially when there is also analgesic overuse, are the most disabling forms of migraine. These three disorders (chronic migraine, refractory migraine and medication overuse headache) are particularly difficult to treat. This article reviews their epidemiology, clinical presentation, diagnostic criteria, risk factors, comorbidities and social and personal impact. The therapeutic options available are discussed and focused on a multidisciplinary approach, non-pharmacological interventions treatment of comorbidities and avoiding analgesic overuse. Prophylactic treatments are mandatory and include the oral prophylactic treatments (topiramate), botulinum toxin type A and the novel monoclonal antibodies against calcitonin gene related peptide or its receptor, which are the first migraine preventive medicines developed specifically to target migraine pathogenesis. In refractory cases, multiple therapies are required including neurostimulation.

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Published

2020-11-02

How to Cite

1.
Parreira E, Luzeiro I, Pereira Monteiro JM. Chronic and Refractory Migraine: How to Diagnose and Treat. Acta Med Port [Internet]. 2020 Nov. 2 [cited 2024 Nov. 22];33(11):753-60. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/12004

Issue

Section

Review Articles