The Journal of Headache and Pain (Aug 2019)

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

  • Elio Clemente Agostoni,
  • Piero Barbanti,
  • Paolo Calabresi,
  • Bruno Colombo,
  • Pietro Cortelli,
  • Fabio Frediani,
  • Pietrangelo Geppetti,
  • Licia Grazzi,
  • Massimo Leone,
  • Paolo Martelletti,
  • Luigi Alberto Pini,
  • Maria Pia Prudenzano,
  • Paola Sarchielli,
  • Gioacchino Tedeschi,
  • Antonio Russo,
  • The Italian chronic migraine group

DOI
https://doi.org/10.1186/s10194-019-1038-4
Journal volume & issue
Vol. 20, no. 1
pp. 1 – 9

Abstract

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Abstract 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.

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