Chronic Migraine: Recognizing Triggers and Effective Solutions

Understanding migraine

Migraine is a neurological disease affecting about 15% of the population. It manifests as unilateral pulsating headaches, often accompanied by nausea, photophobia, and phonophobia. The chronic form is defined by more than 15 headache days per month.

Common triggers

• Stress and anxiety
• Lack or excess of sleep
• Prolonged fasting, dehydration
• Foods: chocolate, aged cheeses, alcohol (red wine), glutamate
• Hormonal variations (periods, contraception)
• Bright light, strong odors, weather changes

Acute solutions

Triptans (sumatriptan, zolmitriptan) at the onset of an attack, NSAIDs (ibuprofen, naproxen), associated antiemetics. New gepants (rimegepant) offer an alternative without vasoconstrictive effects.

Preventive treatments

Beta-blockers (propranolol), topiramate, amitriptyline, candesartan. For resistant chronic migraines: anti-CGRP antibodies (erenumab, fremanezumab, galcanezumab) which significantly reduce the frequency of attacks. Botulinum toxin also has an MA in chronic migraine.

Non-pharmacological approaches

Regular sleep, stress management (meditation, yoga), moderate physical activity, keeping a headache diary to identify triggers. Biofeedback and acupuncture have shown efficacy in several studies.