Internal and Emergency Medicine

, Volume 6, Issue 1, pp 23–28 | Cite as

Rehabilitating chronic migraine complicated by medication overuse headaches: how can we prevent migraine relapse?

  • Ivano Farinelli
  • Ilaria Dionisi
  • Paolo Martelletti
IM - Review


Headache is among the most common neurological symptoms in clinical practice. In some cases of episodic migraine, the headache intensifies into a chronic form, defined as chronic migraine (CM) and such a condition encompasses a headache frequency of 15 days/month, with features similar to those of migraine attacks. The assessment of CM in the US general population ranges around 1.3–2%. Migraine progression from an episodic into a chronic form is realized through a period of time involving several months or years, during which an increase attack frequency occurs. Both Topiramate and Onabotulinum toxin A can be considered to be safe as well as effective medications, therefore, representing a treatment choice. Regarding drug abusers, the initial relief step always consists of drug interruption. Only after detoxification can a new prophylaxis therapy be commenced, which otherwise would be useless from the start. The feasible diagnostic setting for the tailored treatment of CM based on the application of pharmacogenomics will allow us in predetermining the efficacy of a single old and new drugs by avoiding abuse due to non-responsivity of the abused drug.


Chronic migraine Medication overuse headache Detoxification Reprophylaxis 


Conflict of interest



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Copyright information

© SIMI 2010

Authors and Affiliations

  • Ivano Farinelli
    • 1
    • 2
  • Ilaria Dionisi
    • 2
  • Paolo Martelletti
    • 1
  1. 1.Department of Medical and Molecular Sciences, II School of Medicine, Sant’Andrea HospitalSapienza University of RomaRomeItaly
  2. 2.Department of Anaesthesia and Intensive Care Medicine, II School of Medicine, Sant’Andrea HospitalSapienza University of RomeRomeItaly

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