Chronic Migraine

In summary, the baseline treatment for chronic migraine consists of oral medications such as Topiramate, Beta-blockers, Amitriptyline, and Flunarizine, all of which are approved for migraine treatment. Additionally, there is the injectable Botulinum toxin type A, specifically approved for chronic migraine. Before using Botulinum toxin type A, at least two unsuccessful treatment attempts (i.e., no reduction in headache days by at least 50%) with an oral baseline therapy must have been conducted. Treatment with Botulinum toxin type A should be administered at intervals of twelve weeks with two to three injection cycles, as good efficacy often only appears after the second or third treatment.