Current and emerging evidence-based treatment options in chronic migraine: a narrative review

J Headache Pain. 2019 Aug 30;20(1):92. doi: 10.1186/s10194-019-1038-4.


Background: Chronic migraine is a disabling condition that is currently underdiagnosed and undertreated. In this narrative review, we discuss the future of chronic migraine management in relation to recent progress in evidence-based pharmacological treatment.

Findings: Patients with chronic migraine require prophylactic therapy to reduce the frequency of migraine attacks, but the only currently available evidence-based prophylactic treatment options for chronic migraine are topiramate and onabotulinumtoxinA. Improved prophylactic therapy is needed to reduce the high burden of chronic migraine in Italy. Monoclonal antibodies that target the calcitonin gene-related peptide (CGRP) pathway of migraine pathogenesis have been specifically developed for the prophylactic treatment of chronic migraine. These anti-CGRP/R monoclonal antibodies have demonstrated good efficacy and excellent tolerability in phase II and III clinical trials, and offer new hope to patients who are currently not taking any prophylactic therapy or not benefitting from their current treatment.

Conclusions: Treatment of chronic migraine is a dynamic and rapidly advancing area of research. New developments in this field have the potential to improve the diagnosis and provide more individualised treatments for this condition. Establishing a culture of prevention is essential for reducing the personal, social and economic burden of chronic migraine.

Keywords: Anti-CGRP monoclonal antibodies; Chronic migraine; Fremanezumab; Prophylaxis; Topiramate; onabotulinumtoxinA.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal / therapeutic use*
  • Botulinum Toxins, Type A / therapeutic use
  • Chronic Disease
  • Disabled Persons
  • Humans
  • Migraine Disorders / drug therapy*
  • Migraine Disorders / prevention & control
  • Randomized Controlled Trials as Topic
  • Topiramate / therapeutic use


  • Antibodies, Monoclonal
  • Topiramate
  • Botulinum Toxins, Type A