title: Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society.
abstract: Chronic migraine (CM) is a disabling neurological condition affecting 0.5-2 % of the population. In the current third edition of the International Classification of Headache Disorders, medication overuse is no longer an exclusion criterion and CM is diagnosed in patients suffering from at least 15 headache days per month of which at least eight are related to migraine. CM is difficult to treat, and preventive treatment options are limited. We provide a pathogenetic model for CM, integrating the latest findings from neurophysiological and neuroimaging studies. On behalf of the Belgian Headache Society, we present a management algorithm for CM based on the international literature and adapted to the Belgian situation. Pharmacological treatment options are discussed, and recent data on transcranial and invasive neuromodulation studies in CM are reviewed. An integrated multimodal treatment programme may be beneficial to refractory patients, but at present, this approach is only supported by a limited number of observational studies and quite variable between centres.
authors: Department of Neurology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium, koen.paemeleire@uzgent.be.
authors: Koen
authors: K
authors: Paemeleire
authors: Paul
authors: P
authors: Louis
authors: Delphine
authors: D
authors: Magis
authors: Michel
authors: M
authors: Vandenheede
authors: Jan
authors: J
authors: Versijpt
authors: Bart
authors: B
authors: Vandersmissen
authors: Jean
authors: J
authors: Schoenen
mesh_terms: D000465:Algorithms; D001530:Belgium / Q000453:epidemiology; D002908:Chronic Disease; D003072:Cognition Disorders / Q000209:etiology; D016208:Databases, Factual / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D019468:Disease Management; D006801:Humans; D008881:Migraine Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D012955:Societies, Medical / Q000592:standards*