title: New therapeutic developments in chronic migraine.
abstract: OBJECTIVE
  Chronic migraine is a common cause of chronic daily headache, which is often refractory to standard treatment. New research has increased our understanding of this disorder and its treatment. This review focuses on recent clinical trials and advances in our understanding of migraine pathophysiology.
  
  
  RESULTS
  Migraine research has traditionally focused on the more common episodic form of the disorder, but recent clinical trials have started to focus on chronic migraine or chronic daily headache. Topiramate, onabotulinum toxin type A, gabapentin, petasites and tizanidine are among the agents that appear to be effective in the treatment of chronic migraine. New acute medications including an inhaled form of dihydroergotamine will soon be available and neuromodulatory procedures such as occipital nerve stimulation may be effective for the most disabled patients. In the past few years, other studies have shed light on potential risk factors for chronic migraine such as medication-overuse headache, temporomandibular disorders, obstructive sleep apnea and obesity.
  
  
  CONCLUSIONS
  This review explains advances in the treatment of chronic migraine, a common disorder seen in neurological practice. These new advances in preventive treatment and a better understanding of its risk factors will allow clinicians to better identify individuals at greatest risk and prevent the development of chronic migraine.
authors.affiliation: Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. loveb9@gmail.com
authors.forename: Brigitte V
authors.initials: BV
authors.lastname: Lovell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Marmura
mesh_terms: D000700:Analgesics / Q000494:pharmacology* / Q000627:therapeutic use; D000927:Anticonvulsants / Q000494:pharmacology / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000494:pharmacology / Q000627:therapeutic use; D004087:Dihydroergotamine / Q000494:pharmacology / Q000627:therapeutic use; D004599:Electric Stimulation Therapy / Q000379:methods / Q000639:trends; D020773:Headache Disorders / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy* / Q000503:physiopathology; D009480:Neuropharmacology / Q000379:methods / Q000639:trends*; D011315:Preventive Medicine / Q000379:methods / Q000639:trends; D012307:Risk Factors
chemical_list: D000700:Analgesics; D000927:Anticonvulsants; D004087:Dihydroergotamine; D019274:Botulinum Toxins, Type A