Management of chronic migraine is a treatment strategy for headache symptoms occurring more than 15 days per month for at least 3 months. The primary goal is to reduce headache frequency, alleviate pain intensity, and improve patients' quality of life. The treatment plan combines pharmacological therapy, non-pharmacological methods, and lifestyle modifications to achieve long-term control.
This therapy is specifically designed for chronic migraine (Chronic Migraine) patients and is suitable for those receiving both acute relief and preventive treatment. Physicians will develop personalized treatment plans based on the severity of symptoms, medical history, and comorbid conditions.
Mainly divided into two categories: “Acute Treatment” and “Preventive Treatment”:
Emerging therapies such as neural stimulators (e.g., vagus nerve stimulation) modulate brain neural electrical activity through electrical currents to block pain signal transmission. Biologics like CGRP antibodies target specific proteins involved in migraine pathophysiology.
Suitable for patients diagnosed with chronic migraine according to the International Classification of Headache Disorders (ICHD-3), specifically including:
Also applicable to medication-overuse headache (MOH) patients, with medication use behavior correction plans. For those unresponsive to non-invasive therapies, neurostimulation or surgical evaluation may be considered.
Pharmacological treatment follows a stepwise approach:
Non-pharmacological treatments such as botulinum toxin injections are administered subcutaneously every 12 weeks, with precise localization to specific head muscle groups. Neurostimulators require daily use for a specified duration, with treatment cycles typically lasting 3-6 months.
Multimodal therapy can reduce headache days by over 50%, improving daily functioning. Preventive medications decrease the frequency of acute medication use, reducing the risk of medication overuse headache. Non-invasive therapies like transcutaneous electrical stimulation have lower systemic side effects.
Biologics target specific pathophysiological pathways, providing highly targeted treatment. Lifestyle interventions combined with therapy can enhance efficacy, such as stress management training to reduce trigger factors.
Medications may cause gastrointestinal discomfort, palpitations, or peripheral numbness. Long-term use of triptans may lead to medication-overuse headache, requiring strict control of usage frequency.
Botulinum toxin treatment may occasionally cause localized muscle weakness or dizziness. Neurostimulation therapy might induce skin irritation or infection risks. Biologics may trigger allergic reactions or elevated liver enzymes, related to immune responses.
Contraindications include:
Prior to treatment, secondary headache causes such as intracranial hemorrhage or cerebral aneurysm should be excluded. Liver and kidney functions should be evaluated before biologic therapy, with regular monitoring of blood indices and neurological examinations during treatment.
Combination of beta-blockers with calcium channel blockers may enhance cardiovascular side effects. When combined with anticoagulants and NSAIDs, gastrointestinal bleeding risk should be monitored.
Botulinum toxin combined with muscle relaxants may produce additive effects, leading to decreased muscle strength. Herbal medicines like ginkgo extract may affect the efficacy of antiplatelet drugs; full medication lists should be disclosed to the physician.
Large clinical trials show that beta-blockers can reduce headache days by 40-50%, while phase III trials of CGRP antibody drugs demonstrate a median reduction of 50% in headache days. Botulinum toxin significantly alleviates tension-type components of headache.
Randomized controlled trials confirm that combining cognitive-behavioral therapy can enhance drug efficacy by 30%. Long-term follow-up studies indicate that regular preventive treatment can reduce the risk of progressing to chronic migraine by 60% within five years.
Non-pharmacological therapies include:
Natural therapies such as acupuncture and massage can serve as adjunct treatments. For those intolerant to medications, novel monoclonal antibody therapies or personalized treatments guided by genetic testing may be considered.
Patients should strictly follow the prescribed dosage and dosing intervals. Avoid increasing medication frequency or dosage on their own. If headache frequency suddenly increases, assess whether it is disease progression rather than immediately taking additional painkillers. Keeping a headache diary can help physicians adjust treatment plans, and regular follow-ups are essential to evaluate medication safety.
How to choose a qualified TCM practitioner for acupuncture treatment of chronic migraine?It is recommended to select a licensed Traditional Chinese Medicine (TCM) practitioner with experience in headache treatment. Ask the practitioner to explain the treatment plan and expected outcomes. Inform the practitioner of current medications before treatment to avoid interactions. Some insurance plans may cover TCM treatments; confirm copayments and session limits in advance.
Which dietary components may trigger chronic migraine, and how should they be adjusted?Known triggers include processed meats containing nitrates, cheeses high in tyramine, and beverages with artificial sweeteners. Adopt an “elimination diet” by removing suspected foods one by one and observing headache changes. Maintain adequate hydration and regular meals to prevent hypoglycemia-induced headaches.
When experiencing an acute attack, what are the correct timing and methods for cold and hot compresses?In the early stages of an attack, try cold compresses (15-20 minutes) on the scalp or neck pain points. If headache persists for more than 2 hours, switch to warm compresses to promote local blood flow. Ensure ice packs are wrapped in a thin cloth and not applied for more than 30 minutes at a time to prevent frostbite or skin irritation.
For patients receiving botulinum toxin injections, how should persistent head heaviness after treatment be handled?Mild head heaviness is a common reaction after botulinum toxin treatment and usually subsides within 1-2 weeks. If symptoms last over 3 weeks or are accompanied by blurred vision, seek immediate medical attention to exclude injection misplacement. Avoid massaging the injection sites and follow up regularly to monitor pain improvement and medication adjustments.
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