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Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

Abstract

Chronic migraine (CM) is a disabling neurological condition affecting 0.5–2 % of the population. In the current third edition of the International Classification of Headache Disorders, medication overuse is no longer an exclusion criterion and CM is diagnosed in patients suffering from at least 15 headache days per month of which at least eight are related to migraine. CM is difficult to treat, and preventive treatment options are limited. We provide a pathogenetic model for CM, integrating the latest findings from neurophysiological and neuroimaging studies. On behalf of the Belgian Headache Society, we present a management algorithm for CM based on the international literature and adapted to the Belgian situation. Pharmacological treatment options are discussed, and recent data on transcranial and invasive neuromodulation studies in CM are reviewed. An integrated multimodal treatment programme may be beneficial to refractory patients, but at present, this approach is only supported by a limited number of observational studies and quite variable between centres.

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Conflict of interest

Koen Paemeleire received honoraria as a speaker, advisor or investigator in clinical studies from Allergan, Almirall, Autonomic Technologies Inc, Coherex, Janssen-Cilag, Medtronic, Pfizer, Sandoz, and St Jude Medical. Paul Louis has received honoraria as investigator in clinical studies from Glaxo-Smith-Kline, Pfizer, Almirall, Janssen Pharmaceutica, Boehringer Ingelheim and Merck (MSD), as well as honoraria for lectures from Eli Lilly and as member of the advisory board for Allergan. Delphine Magis reports no conflict of interest. Michel Vandenheede received honoraria as member of the advisory board for Allergan. Jan Versijpt reports to be a member of the advisory board/consultant for Allergan. Bart Vandersmissen reports personal fees from Allergan. Jean Schoenen is part of the advisory board/consultant for BMS, Amgen, Allergan, Colucid, Boehringer, Merck, Almirall, Pfizer, Medtronic, Gammacore, ATI, Cefaly-Technology, St Jude Medical and Chordate.

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Paemeleire, K., Louis, P., Magis, D. et al. Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society. Acta Neurol Belg 115, 1–17 (2015). https://doi.org/10.1007/s13760-014-0313-z

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  • DOI: https://doi.org/10.1007/s13760-014-0313-z

Keywords

  • Chronic migraine
  • Botulinum toxin
  • Topiramate
  • Neurostimulation
  • Pathophysiology
  • Algorithm