Chronic Migraine and Medication Overuse
I am Christoph Diener, a neurologist at the University of Essen in Germany. My topic today is chronic migraine and the treatment of chronic migraine.
Chronic migraine is defined as headaches occurring on more than15 days per month, with at least 8 days to fulfill the criteria of migraine without aura. This condition is very difficult to treat. There are only 2 effective and approved treatments: topiramate and botulinum toxin.
A considerably large subgroup of patients with chronic migraine overuses medication. A subgroup analysis of the large-scale clinical trials that led to the approval of botulinum toxin (a predefined substudy) was published recently, looking at patients from the PREEMPT trial who had medication overuse. We have to carefully differentiate between "medication overuse" (which is intake of a triptan on more than 10 days per month, or analgesics on more than 15 days per month) and "medication overuse headache."