Navigating Treatment Decisions, Complications for Chronic Migraine: Dolores Santamaria, MD

WATCH TIME: 8 minutes

"As you see options and variations, there’s not an algorithm that I can give exactly. It depends on how young, what’s happening with insurances, what have they tried before, and specifically, their condition."

Chronic migraine is defined as having headache on at least 15 days per month, with 8 of these having migraine symptoms, for at least 3 months. Symptoms for chronic migraine include frequent headache, increased sensitivity to light, sounds or smell, nausea, vomiting, aura, dizziness, and vertigo. Around 2.5 out of 100 people with episodic migraine with develop chronic migraine each year, with several medical conditions such as depression, anxiety, fibromyalgia, sleep apnea, and postural orthostatic tachycardia syndrome, that may increase the tendency to have migraine.

Treating chronic migraine can be a challenge for some clinicians, and usually will involve both drug and non-drug options. Medication overuse headache, which occurs when acute treatments such as triptans or over-the-counter painkillers are taken on too many days of the month, is experienced by nearly two-thirds of patients with chronic migraine. These patients also have a range of preventive options, from beta-blockers, tricyclic antidepressants, anti-epilepsy drugs, and blood pressure tablet candesartan; however, the access to preventives only comes after patients have failed other treatments.

Recently, NeurologyLive^® sat down with Dolores Santamaria, MD, director of the headache center at Allegheny Health Network, to discuss some of the successful approaches to treating chronic migraine, and the complications that come with it. She provided perspective on challenges with insurance, the need to treat whole-body and not just migraine, and the steps taken when treatments are ineffective.