Not all chronic migraines are medication-overuse headaches and so the challenge is how to treat them. Currently available pharmacological therapies may be ineffective or they are abandoned because of intolerable side effects. There is still much room for novel therapeutic approaches in those with drug refractory migraine (RM). Occipital nerve stimulation (ONS) and botulinum toxin type A have finally gained a level of evidence based on the results of RCTs and pooled analysis, which by and large have shown at least a modest but valuable therapeutic effect. For a long time, these two approaches were only supported by clinical experience and open-label studies. Considering the disabling nature of migraine disorder, the large prevalence and serious impact on health-related quality of life and health care costs, any degree of response to treatment is acceptable and welcomed by the patient. An important issues for future studies would be better patient selection when finding candidates for each procedure.
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Dr. Alberto Proietti Cecchini and Dr. Licia Grazzi each declare no potential conflicts of interest relevant to this article.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Chronic Daily Headache
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Proietti Cecchini, A., Grazzi, L. Emerging Therapies for Chronic Migraine. Curr Pain Headache Rep 18, 408 (2014). https://doi.org/10.1007/s11916-014-0408-5
- Occipital nerve stimulation
- Chronic migraine
- Refractory migraine
- Chronic pain
- Botulinum toxin type A