Arquivos de Neuro-Psiquiatria ()

Consensus of the Brazilian Headache Society on the treatment of chronic migraine

  • Fernando KOWACS,
  • Célia Aparecida de Paula ROESLER,
  • Élcio Juliato PIOVESAN,
  • Elder Machado SARMENTO,
  • Henrique Carneiro de CAMPOS,
  • Jayme Antunes MACIEL JR,
  • Leandro Cortoni CALIA,
  • Liselotte Menke BAREA,
  • Marcelo Cedrinho CICIARELLI,
  • Marcelo Moraes VALENÇA,
  • Maria Eduarda Nobre de Magalhães COSTA,
  • Mário Fernando Prieto PERES,
  • Pedro André KOWACS,
  • Pedro Augusto Sampaio ROCHA-FILHO,
  • Raimundo Pereira da SILVA-NÉTO,
  • Thais Rodrigues VILLA,
  • Mauro Eduardo JURNO

DOI
https://doi.org/10.1590/0004-282x20190078
Journal volume & issue
Vol. 77, no. 7
pp. 509 – 520

Abstract

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ABSTRACT Chronic migraine poses a significant personal, social and economic burden and is characterized by headache present on 15 or more days per month for at least three months, with at least eight days of migrainous headache per month. It is frequently associated with analgesic or acute migraine medication overuse and this should not be overlooked. The present consensus was elaborated upon by a group of members of the Brazilian Headache Society in order to describe current evidence and to provide recommendations related to chronic migraine pharmacological and nonpharmacological treatment. Withdrawal strategies in medication overuse headache are also described, as well as treatment risks during pregnancy and breastfeeding. Oral topiramate and onabotulinum toxin A injections are the only treatments granted Class A recommendation, while valproate, gabapentin, and tizanidine received Class B recommendation, along with acupuncture, biofeedback, and mindfulness. The anti-CGRP or anti-CGRPr monoclonal antibodies, still unavailable in Brazil, are promising new drugs already approved elsewhere for migraine prophylactic treatment, the efficacy of which in chronic migraine is still to be definitively proven.

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