Fast Five Quiz: Treatment of Chronic Migraine

Jasvinder P. Chawla, MD, MBA 


March 07, 2022

According to guidance from the American Headache Association (AHA), body habitus should be considered when selecting preventive treatment for patients with chronic migraine. Other important considerations include evidence for efficacy; provider experience; tolerability; patient preference; headache subtype; comorbid and coexistent illnesses; concomitant medications; physiologic factors (eg, heart rate, blood pressure); and pregnancy or the potential for pregnancy among women.

Presently, no oral preventive treatments designed specifically for migraine are available.

Biobehavioral therapy (eg, cognitive behavioral therapy and biofeedback) as well as relaxation therapies have been shown to be effective as preventive treatment of migraine. Nonpharmacologic treatments might be especially suitable for patients who:

  • Prefer nonpharmacologic interventions

  • Have inadequate response to, poor tolerance of, or medical contraindications to specific pharmacologic therapies

  • Are pregnant, lactating, or planning to become pregnant

  • Have a history of acute medication overuse

  • Display significant stress or poor stress-coping skills

The AHA recommends avoiding use of a single drug for multiple conditions when there is a risk for undertreatment of any particular condition.

Learn more about the treatment of chronic migraine.


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