Speaking at the Congress of the European Pain Federation EFIC in Florence today, Professor Paolo Martelletti of Rome said of chronic migraine, “The disruptive nature of regular attacks can affect those around them and prove detrimental to many aspects of everyday life, bringing about high levels of stress and often depression.” He also stressed that people with chronic migraine report more co-morbidities than episodic migraine sufferers. “As many of these diseases – like obesity, high blood pressure and anxiety disorders – have high prevalence rates in the general population, it’s possible that your patients with chronic migraine may be visiting your office to discuss these disorders and not their migraines.”

Martelletti noted that a particular problem with migraine treatment is the high frequency of medication overuse. Medication overuse is defined as regular use of combination analgesics, ergotamines, triptans or opioids on ten or more days a month, for more than three months; or regular use of simple analgesics or any combination of these drugs on more than 15 days per month for more than three months without overuse of any single class alone. Martelletti stated that medication overuse should be treated by withdrawing acute medications, and with the use of preventives.

Experts at the congress also agreed there is a large unmet need in the management of headache disorders. However, one new positive therapy was discussed – botulinum toxic type A, or Botox. The PREEMPT program which led to the licensing of the substance, evaluated the safety profile and efficacy of botulinum toxin as a prophylactic headache treatment in chronic migraineurs. “In clinical practice, as long as we manage our patients’ expectations and help them set realistic goals, Botox injections provide a valuable, evidence-based approach to the treatment of chronic migraine. Regular treatments with Botox provide an effective approach to the long-term management of chronic migraine and may have a disease-modifying effect in some cases where the new chronic condition, though not entirely cured, may revert to its episodic form,” said Martelletti……   Medical News Today     10/14/13


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