Other names: Migraine, Chronic

Migraine is a type of headache characterized by throbbing pain on one or both sides of the head, and usually accompanied by nausea, vomiting or loss of appetite. Some people may also experience an aura, which is the sudden onset of changes in vision before the migraine begins.

Chronic migraine is defined as having 15 or more headache days per month, with headaches lasting four hours a day or longer and at least half those headache days being associated with migraine.
People who have 14 or less headache days per month are defined as having episodic migraine.

Symptoms of chronic migraine include:

• headache
• visual disturbances
• nausea and vomiting
• sensitivity to light
• sensitivity to noise

Treatment of chronic migraine includes preventive treatments such as Botox (onabotulinumtoxinA),  the calcitonin gene-related peptide (CGRP) antagonists, and medicines used for the acute treatment of migraine such as analgesics, triptans, and oral gepants.

Botox (onabotulinumtoxinA) is FDA approved for the preventive treatment of chronic migraine.

Botox works by inhibiting the release of the neurotransmitter acetylcholine from nerve cells, blocking the signals that induce muscle contractions. It is administered by injection into seven specific areas of the head and neck muscles, with results lasting up to 12 weeks depending on the individual patient.

Aimovig (erenumab-aooe), Ajovy (fremanezumab-vfrm), Emgality (galcanezumab-gnlm), and Vyepti (eptinezumab-jjmr) are all approved for the preventive treatment of migraine, including chronic migraine. These drugs belong to the class of drugs called calcitonin gene-related peptide (CGRP) antagonists which work by blocking the activity of the calcitonin gene-related peptide, a neuropeptide that has been implicated in the pain and vasodilation processes associated with migraine attacks.

Drugs used to treat Chronic Migraine