Chronic migraine: diagnosis and treatment

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Abstract

Chronic migraine (CM) is a specific form of migraine characterized by headache frequency exceeding 15 days per month, with at least 8 headache days being migrainous. The prevalence of CM in the general population ranges from 1.4 to 2.3%, reaching 6.8% in Russia.

CM significantly impairs patients’ ability to work and their quality of life, causes significant economic losses, and poses a serious problem for both patients and the national healthcare system.

This article presents current literature data reflecting modern understanding of the diagnosis and differential diagnosis of CM, as well as factors that contribute to its chronicity, and discusses current therapeutic approaches. According to the 2024 International Headache Society (IHS) guidelines, migraine-specific (targeted) medications are recommended as the primary treatment for migraine and CM. If necessary, they can be combined with other non-specific oral medications recommended for the treatment of migraine and comorbid conditions due to their different mechanisms of action.

Using the CGRP mAb erenumab, which blocks the CGRP receptor on the postsynaptic membrane and is one of the most effective and safe migraine prophylactic agents, it has been shown to halve the number of migraine days per month after just 3 months of therapy.

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About the authors

E. G. Filatova

I.M. Sechenov First Moscow State Medical University (Sechenov University); Alexander Vein Headache and Autonomic Disorders Clinic

Author for correspondence.
Email: eg-filatova@mail.ru

Dr. Sci. (Med.), Professor of the Department of Nervous System Diseases, Institute of Postgraduate Education

Russian Federation, Moscow; Moscow

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2. Figure 1. Probability of migraine chronification depending on baseline headache frequency

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3. Figure 2. Probability of migraine chronification with varying pain relief efficacy

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4. Figure 3. Results after 3 months of treatment with erenumab

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