Chronic migraine affects up to 20 million people worldwide, with recent research revealing significant advances in both treatment approaches and understanding of progression risks, according to a clinical review published in JAMA.

The review, authored by Rebecca Burch, MD, from the University of Vermont Larner College of Medicine, outlines that chronic migraine is defined by headaches occurring on 15 or more days monthly, with at least 8 meeting migraine criteria or responding to migraine-specific medications.

A notable finding concerns medication overuse, which emerges as a significant risk factor. "As many as 65% of people with chronic migraine meet the International Classification of Headache Disorders criteria for acute medication overuse," the review states. Research indicates this carries an 8.8-fold increased risk of progression from episodic to chronic migraine.

In terms of treatment data, a randomized trial of 778 individuals with chronic migraine demonstrated that atogepant, a calcitonin gene-related peptide receptor antagonist, reduced mean monthly migraine days by 7.5 with 30 mg twice daily dosing, compared to 5.1 days with placebo. The least-squares mean difference from placebo was -2.4 (95% CI, -3.5 to -1.3; adjusted P < .001).

The review also highlights the potential of behavioral interventions. One study found that 78.4% of patients receiving mindfulness therapy alongside usual care achieved a 50% or greater reduction in headache frequency at 12 months, compared to 48.3% with usual care alone.

"Optimization of acute and preventive migraine treatment reduces disability and improves quality of life in people with chronic migraine," concludes Dr. Burch, emphasizing the importance of comprehensive treatment approaches.

The review suggests that effective management strategies should include consideration of both pharmacologic and non-pharmacologic interventions, with particular attention to avoiding medication overuse while maintaining adequate symptom control.

The author of the clinical review reported receiving compensation from the American Academy of Neurology for serving as an associate editor of Neurology.