How is chronic migraine treated?

Treatment of chronic migraine is focused on managing lifestyle choices and headache triggers, managing migraine attacks and providing preventive treatments to reduce migraine attacks.

Lifestyle changes include:

  • Losing weight if you are overweight.
  • Beginning an exercise plan that has been approved by your doctor.
  • Managing your stress. Learn techniques to control stress such as meditation, yoga, relaxation training, or mindful breathing.
  • Developing a routine regimen regarding meal and snack times; do not skip meals.
  • Staying well hydrated.
  • Beginning treatment for any existing mood disorder (including depression and anxiety) or sleep problem.

The typical treatment plan for managing migraine attacks includes:

  • Treating migraine attacks early when pain in mild; begin with a simple pain killer (paracetamol, aspirin, ibuprofen, naproxen) and slowly increase the dose as needed to the max tolerated dose, unless the headache is severe at the start or will become severe. In such cases add a triptan to the above medication to improve efficacy. Avoid use of opiates if possible. Your doctor will devise a treatment plan to avoid worsening chronic headache by overusing medications.
  • Treat associated side effects, such as nausea.
  • Consider other treatment techniques, including transcranial magnetic stimulation and transcutaneous supraorbital nerve stimulation.

Preventive treatment is aimed at reducing the number of headaches. Preventive treatments include:

  • Beta blockers, such as propranolol (Inderal®), atenolol (Tenormin®) and metoprolol (Lopressor®)
  • Angiotensin blockers, such as candesartan (Atacand®)
  • Tricyclic antidepressants, such as nortriptyline (Pamelor®), amitriptyline (Elavil®)
  • Anticonvulsants, such as topiramate (Topimax®), sodium valproate
  • Flunarizine (Sibelium®)
  • Onabotulinum toxin A (Botox®) injections
  • Calcitonin gene-related peptide (CGRP), such as galcanezumab (Emgality®), fremanezumab (Ajovy®), erenumab (Aimovig®)

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