10. Managing the Special Problem of Chronic Migraine

  1. Matthew S. Robbins MD,
  2. Brian M. Grosberg MD and
  3. Richard B. Lipton MD
  1. Marcelo E. Bigal

Published Online: 19 JUL 2013

DOI: 10.1002/9781118678961.ch10



How to Cite

Bigal, M. E. (2013) Managing the Special Problem of Chronic Migraine, in Headache (eds M. S. Robbins, B. M. Grosberg and R. B. Lipton), John Wiley & Sons, Ltd, Oxford, UK. doi: 10.1002/9781118678961.ch10

Editor Information

  1. Montefi ore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA

Author Information

  1. Albert Einstein College of Medicine, Bronx, NY, USA

Publication History

  1. Published Online: 19 JUL 2013

ISBN Information

Print ISBN: 9780470654729

Online ISBN: 9781118678961



  • Chronic migraine;
  • progression;
  • classification;
  • treatment;
  • management


Chronic migraine (CM) is characterized by 15 days or more of headache per month and 8 or more days of migraine or use of acute migraine medications. It is one of the most common headaches seen in neurology offices and headache clinics. In this chapter the authors review the clinical features and classification of CM, followed by a discussion on effective treatment regimens, with emphasis on the following steps: (1) education and support to the patient, establishing expectations and a follow-up plan; (2) use of nonpharmacological and behavioral therapies; (3) discontinuation of overused and potentially offending medications plus caffeine by outpatient or inpatient detoxification procedures; and (4) institution of a program of acute care and preventive pharmacological therapy. We close by discussing reasons for treatment failure for CM.