Most oral preventive pharmacologic therapies for chronic migraine have been shown to have only modest efficacies and therapeutic gains < 50% compared with placebo. Improved efficacy and tolerability may be achieved with onabotulinumtoxinA and small-molecule calcitonin gene–related peptide receptor antagonists (which are administered subcutaneously).
Antiepileptics, antidepressants, and antihypertensives may be considered in the first line for preventive therapy given their affordability. For any of these agents, migraine prophylaxis should not be deemed a failure until the maximum tolerable dose has been administered for a minimum of 30 days. Onset of positive treatment response can be quite prolonged.
Learn more about the various drug classes used in the treatment of chronic migraine.
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Cite this: Jasvinder P. Chawla. Fast Five Quiz: Treatment of Chronic Migraine - Medscape - Mar 07, 2022.