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Treatment of Chronic Migraine

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Abstract

Chronic migraine is defined in different ways. The most commonly used definition is headache on more than 15 days per month in patients with migraine. Chronic migraine is difficult to treat and requires a multidisciplinary approach. Only two pharmacological treatments have been shown to be effective in placebo-controlled randomized trials: topiramate and local injection of botulinum toxin. Both therapies are effective in patients with chronic migraine with and without medication overuse. Many other substances have been investigated in chronic daily headache. All trials were underpowered and, therefore, recommendations concerning possible efficacy are not possible.

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Disclosures

Dr. Hans-Christoph Diener has received grants from the German Research Council, the German Ministry of Education and Science, the European Union, Allergan, Almirall, AstraZeneca, Bayer, GlaxoSmithKline, Janssen-Cilag, and Pfizer; has received consulting fees or honoraria from Addex Pharmaceuticals, Allergan, Almirall, AstraZeneca, Bayer Vital, Berlin-Chemie AG, Coherex Medical, CoLucid Pharmaceuticals, Boehringer Ingelheim, GlaxoSmithKline, Janssen-Cilag, Minster Pharmaceuticals, MSD Pharmaceuticals, Novartis AG, Johnson & Johnson, Sanofi-Aventis and Medtronic; and has received travel support and fees for participation in review activities (eg, data monitoring boards, statistical analysis, end point committees, etc.) from Addex Pharmaceuticals, Allergan, Almirall, AstraZeneca, Bayer Vital, Coherex Medical, CoLucid Pharmaceuticals, Boehringer Ingelheim, BristolMyersSquibb, GlaxoSmithKline, Janssen-Cilag, MSD Pharmaceuticals, Novartis AG, Johnson & Johnson, Laboratories, Sanofi-Aventis, and Medtronic. Dr. Dagny Holle: none. Dr. David Dodick has served as a consultant for, and has received honoraria from, Boston Scientific, Medtronic, ATI (now Armstrong) Pharmaceuticals, Merck and Co., Pfizer, MAP Pharmaceuticals, NeurAxon, Bristol-Myers-Squibb, Neuralieve, CoLucid, Eli Lilly and Company, Zogenix, and Coherex; has received grants from, or has grants pending with, St. Jude Medical, Medtronic, and Advanced Neurostimulation Systems; has received payment for the development of educational presentations from Miller Medical, the Annenberg Foundation, and IntraMed; and has received travel expense compensation from IntraMed, Coherex, and Neuralieve.

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Diener, HC., Holle, D. & Dodick, D. Treatment of Chronic Migraine. Curr Pain Headache Rep 15, 64–69 (2011). https://doi.org/10.1007/s11916-010-0159-x

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