Treatment Update of Chronic Migraine

Curr Pain Headache Rep. 2017 Jun;21(6):26. doi: 10.1007/s11916-017-0628-6.


Purpose of review: Although chronic migraine (CM) is a common disorder that severely impacts patient functioning and quality of life, it is usually underdiagnosed, and treatment responses often remain poor even after diagnosis. In addition, effective treatment options are limited due to the rarity of randomized controlled trials (RCTs) involving patients with CM. In the present review, we discuss updated pharmacological, non-pharmacological, and neurostimulation treatment options for CM.

Recent findings: Pharmacological treatments include both acute and preventive measures. While acute treatment options are similar between CM and episodic migraine (EM), preventive treatment with topiramate and botulinum toxin A exhibited efficacy in more than two RCTs. In addition, several studies have revealed that behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation techniques are associated with significant improvements in symptoms. Thus, these treatment options are recommended for patients with CM, especially for refractory cases. Neurostimulation procedures, such as occipital stimulation, supraorbital transcutaneous stimulation, non-invasive vagal nerve stimulation, and transcranial direct current stimulation, have shown promising results in the treatment of CM. However, current studies on neurostimulation suffer from small sample size, no replication, or negative results. Although CM is less responsive to treatment compared to EM, recent advance in pharmacological, non-pharmacological, and neurostimulation treatments may provide more chance for successful treatment of CM.

Keywords: Behavioral treatment; Chronic daily headache; Chronic migraine; Headache; Migraine; Pharmacological treatment.

Publication types

  • Review

MeSH terms

  • Biofeedback, Psychology
  • Botulinum Toxins, Type A / therapeutic use
  • Chronic Pain / therapy*
  • Cognitive Behavioral Therapy
  • Electric Stimulation Therapy / methods
  • Fructose / analogs & derivatives
  • Fructose / therapeutic use
  • Humans
  • Migraine Disorders / therapy*
  • Neuroprotective Agents / therapeutic use
  • Quality of Life
  • Relaxation Therapy
  • Topiramate
  • Transcranial Direct Current Stimulation
  • Treatment Outcome
  • Vagus Nerve Stimulation


  • Neuroprotective Agents
  • Topiramate
  • Fructose
  • Botulinum Toxins, Type A