Chronic Migraine Treatment Options for Now and Later

Migraine is a common and disabling neurological disorder that can be further classified based on headache days. Episodic migraine is characterized by having fewer than 15 headache days a month, while chronic migraine is characterized by having at least 15 headache days a month, for more than 3 months, with at least 8 of those days having migraine features (i.e., light and noise sensitivity and/or nausea). Treatment for chronic migraine exists and can certainly make a difference in one’s quality of life.

“Migraine is a complex, disabling neurological disorder,” says Dr. Moises Dominguez, Assistant Professor of Clinical Neurology and Director of the Headache Medicine Fellowship program at Weill Cornell Medicine, who specializes in headache medicine. “Because individuals have a unique migraine experience, we have to tailor their treatments to their specific needs.”

Keep reading to uncover options for treating chronic migraine and how you can reduce the frequency of your headaches.

Acute Treatment: Treatment Plans That Help Right Now

The goal of acute treatment is to achieve headache relief and make the migraine attack less disabling. If you’re experiencing a migraine attack right now, treatment options include:

• Simple analgesics, such as acetaminophen, ibuprofen, and naproxen. These treatments are often found over the counter.
• Combined analgesics, such as the combination of acetaminophen, aspirin, and caffeine, which can be found over the counter.
• Triptans, which were the first migraine-specific acute treatment. In the United States, a prescription is required. Examples include sumatriptan, rizatriptan, and naratriptan; there are 7 triptans in total.
• Gepants, which include rimegepant, ubrogepant, and zavegepant, and are also migraine-specific acute treatments.

There are also neuromodulation devices that can be used as acute treatment. It would be best to use an acute treatment as soon as symptoms develop, as this can make the medication more effective. At the same time, using acute medications too frequently can lead to medication-overuse headache, which can contribute to the transition from episodic to chronic migraine—another reason prevention is so important.

Preventive Treatment for Chronic Migraine

Thanks to ongoing medical advances, a number of therapies are available to help reduce the frequency, duration, and severity of your migraine attacks.

“With chronic migraine,” Dr. Dominguez says, “migraine prevention is key.”

Preventive chronic migraine treatments you may benefit from include:

• Behavioral therapies. Biofeedback and cognitive-behavioral therapy for migraine can be helpful. As many as 60% of those who use this approach reduce migraine frequency, according to the American Migraine Foundation.
• Migraine non-specific medications. These were originally developed for other conditions and later found to help with migraine. They include:
• Blood pressure medications, such as propranolol and candesartan
• Antidepressants, such as amitriptyline and venlafaxine
• Antiseizure medications, such as topiramate
• Migraine-specific medications, including the calcitonin gene-related peptide (CGRP) inhibitors. This class of treatment represents the first migraine-specific preventive therapy, which is a great example of how our understanding of migraine pathophysiology is expanding. Treatments include three options:
• A quarterly infusion
• A monthly injectable (with one option available every three months)
• A daily pill for chronic migraine or episodic migraine, or an every other day pill for episodic migraine
• Botulinum toxin injections. Every three months, your health provider gives you a series of Botox injections. These injections target nerves in the head and neck and modulate pain signals. This treatment is approved by the FDA as a preventive treatment for chronic migraine.

Having a discussion with your doctor is helpful to learn about the treatment options, as effective treatment can help you regain your life from migraine.

“One of the most important means of preventing the transition from episodic to chronic migraine is properly diagnosing the headache disorder,” Dr. Dominguez says. “Once we identify the problem, we can implement appropriate treatment, evaluate why someone has headaches so often and address potential risk factors.”

The Bottom Line on Chronic Migraine Treatment

Treatment for chronic migraine exists, and understanding what treatment options are available and safe for you can help bring relief.

Medication treatment of migraine can be divided into two domains: acute and preventive treatment. Early diagnosis and implementation of effective treatment, along with lifestyle modification or other conservative treatments, can go a long way in regaining your life from chronic migraine.

With the right treatment, you can experience fewer migraines. Find a doctor at Weill Cornell Medicine to get started.