Abstract
Chronic migraine poses a significant personal, social and economic burden and is characterized by headache present on 15 or more days per month for at least three months, with at least eight days of migrainous headache per month. It is frequently associated with analgesic or acute migraine medication overuse and this should not be overlooked. The present consensus was elaborated upon by a group of members of the Brazilian Headache Society in order to describe current evidence and to provide recommendations related to chronic migraine pharmacological and nonpharmacological treatment. Withdrawal strategies in medication overuse headache are also described, as well as treatment risks during pregnancy and breastfeeding. Oral topiramate and onabotulinum toxin A injections are the only treatments granted Class A recommendation, while valproate, gabapentin, and tizanidine received Class B recommendation, along with acupuncture, biofeedback, and mindfulness. The anti-CGRP or anti-CGRPr monoclonal antibodies, still unavailable in Brazil, are promising new drugs already approved elsewhere for migraine prophylactic treatment, the efficacy of which in chronic migraine is still to be definitively proven.
Highlights
METHODSA group of 17 members of the Brazilian Headache Society met on September 29–30, 2018, after a process of literature searches made by five subgroup coordinators
Chronic migraine poses a significant personal, social and economic burden and is characterized by headache present on 15 or more days per month for at least three months, with at least eight days of migrainous headache per month
After the publication of the third edition of the International Classification of Headaches Disorders (ICHD-3)[4] and considering new evidence published since the Latin American Consensus on Guidelines for the Treatment of Chronic Migraine was reached in 20125,6, the Brazilian Headache Society (Sociedade Brasileira de Cefaleia) recognized the need to elaborate on a new consensus on this subject
Summary
A group of 17 members of the Brazilian Headache Society met on September 29–30, 2018, after a process of literature searches made by five subgroup coordinators. It has been approved since 2011 by Anvisa (Agência Nacional de Vigilância Sanitária: the Brazilian government agency equivalent to the FDA) for use in the prophylactic treatment of chronic migraine in adults This approval was based on a pooled analysis of two large double-blind clinical trials (PREEMPT 1 and 2), which demonstrated significant reduction in headache days and improvement in the patients’ quality of life during the trial period, effects observed in those patients with medication overuse (class of evidence I, level of recommendation A)[95,96,97]. Another multicenter doubleblind RCT did not show a reduction in the number of attacks compared with a sham procedure control group, except in the open phase, after eight months of treatment[129]
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