Optimizing Acute Headache Treatment in the Setting of Chronic Migraine

Abstract

Chronic migraine (CM) is a prevalent neurologic disorder which accounts for a disproportionate share of the direct and indirect costs associated with migraine generally. Successful suppression of CM typically requires an integrated management plan whose various components include the aggressive treatment of acute headache episodes while avoiding overuse of symptomatic medication. Patients with CM frequently will need multiple self-administered therapies to treat the various stages of their acute “breakthrough” headaches, and when self-administered therapy fails, rapid access to enlightened provider-administered treatment should be available. Left unchecked, status migrainosus will reinforce CM, with prolonged attacks of severe migrainous head pain provoking biologic sensitization of the pathways that subserve head pain conduction and undermining prophylactic therapies intended to desensitize those pathways. In this chapter we discuss pharmacologic strategies intended to terminate acute migrainous headache successfully.