Chronic migraine affects approximately 1–2% of the global population and accounts for around 8% of all migraine sufferers.
Chronic migraine is a disabling neurological disorder defined as headache occurring on 15 or more days per month for at least 3 months, with migraine features present on at least 8 of those days. Chronic migraine is multifactorial, involving genetic predisposition, neurological hypersensitivity, and modifiable risk factors.
Management is multimodal and focuses on reducing headache frequency, preventing progression, and improving quality of life. Since the presentation of chronic migraine can overlap with other headache types, thorough assessment and headache phenotyping are essential to guide targeted and appropriate treatment options.
Lifestyle changes, avoidance of precipitating factors and triggers, regular exercise, and good sleep hygiene are widely recommended as preliminary management strategies.
Regarding targeted therapies, I offer the following treatments:
a. Acute management with medication titration, including anti-CGRP drugs
b. Preventative treatments with conventional therapies and newer CGRP monoclonal antibodies (infusions as well as oral therapies, as deemed appropriate)
c. Botox infiltration
d. Neuromodulation (peripheral nerve stimulator, occipital nerve stimulator, etc., depending on thorough assessment)
You can request your GP to arrange a named consultant referral to the Barts neuromodulation service to access these advanced treatment options if they are not available in your area.