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Author(s): Parreira, E
Luzeiro, I
Pereira-Monteiro, J
Title: Chronic and Refractory Migraine: How to Diagnose and Treat
Publisher: Ordem dos Médicos
Issue Date: 2020
Abstract: Migraine is highly prevalent and carries a significant personal, social and economic burden. It is the second cause of disability (years living with disability) worldwide and the first cause under 50 years of age. Chronic migraine (occurring for more than 15 days a month) and refractory migraine (treatment resistant), especially when there is also analgesic overuse, are the most disabling forms of migraine. These three disorders (chronic migraine, refractory migraine and medication overuse headache) are particularly difficult to treat. This article reviews their epidemiology, clinical presentation, diagnostic criteria, risk factors, comorbidities and social and personal impact. The therapeutic options available are discussed and focused on a multidisciplinary approach, non-pharmacological interventions treatment of comorbidities and avoiding analgesic overuse. Prophylactic treatments are mandatory and include the oral prophylactic treatments (topiramate), botulinum toxin type A and the novel monoclonal antibodies against calcitonin gene related peptide or its receptor, which are the first migraine preventive medicines developed specifically to target migraine pathogenesis. In refractory cases, multiple therapies are required including neurostimulation.
Subject: Headache Disorders, Secondary/chemically induced
Migraine Disorders/diagnosis
Migraine Disorders/drug therapy
Source: Acta Medica Portuguesa, vol.33(11), p. 753-760
Document Type: Artigo em Revista Científica Nacional
Rights: openAccess
Appears in Collections:I3S - Artigo em Revista Científica Nacional

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