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

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.

Ferramentas Da Biologia Molecular No Estudo Das Doenças Emergentes E Reemergentes Como a Covid-19

“…A enxaqueca crônica é conhecida como uma perturbação de difícil tratamento, em especial quando associado ao uso em excesso de medicamentos. Atualmente, novas terapias para a enxaqueca estão sendo testadas (KOWACS et al, 2019).…”

Headache catastrophization and its relationship with disability, depression, anxiety, stress and sleep quality

“…Other studies also report that patients with chronic daily headache evidence low concentration and production capacity, anxiety, depression, and hopelessness, and also overlapping two or more psychological disorders. 16,22,24 In this same direction, other research identified that patients diagnosed with migraine were more likely to show complaints related to mood, irritability, difficulties in performing daily tasks, with impaired functionality and quality of life aspects. 25,26 This finding considered pain catastrophization as a process that includes psychosocial factors and correlates with the individual's perception of pain intensity, together with a substantial self-reported functional disability.…”

“…The scale total is the sum of the scores, and scores range from 0 to 56, and the higher the score, the greater the stress. 15,16 The Pittsburgh Sleep Quality Index was applied to assess the sleep quality of the previous month. The global score ranges from 0 to 21 points, and the highest the score, the worse the quality of sleep.…”

Monoclonal Antibodies Targeting CGRP: From Clinical Studies to Real-World Evidence—What Do We Know So Far?

“…It is also stated that, in patients with CM and MOH, the use of anti-CGRP/R mAbs can be initiated before or after withdrawal of acute medications. Several national headache societies have published recommendations on the use of anti-CGRP/R mAbs for migraines [ 96 , 97 , 98 ].…”