The Chronic Migraine Education Program (CMEP) gives frontline practitioners a bird’s eye view of chronic migraine. It introduces concepts about diagnosis, on risk factors, of what to watch out for patients who may have frequent episodic migraine and the risk factors for conversion to chronic migraine. We also educate about the differences between episodic and chronic migraine and how chronic migraine patients are a lot more disabled. They present with a lot of comorbidities and they might need a more comprehensive treatment approach looking at both medication management and behavior management. I think that identifying who is at risk for chronic migraine and identifying some of those risks, particularly overuse of medications and general analgesics is very important. Patients with episodic migraine who are put on analgesics for other pain conditions, let’s say back pain or ankle pain, may become more predisposed to chronic migraine.
In recent years, onabotulinum toxin A was approved by the FDA for chronic migraine. I think that in general, perhaps primary care physicians are not administrating these, but some knowledge about this therapy is important nonetheless. We found that in the research trials, overall in 15 months, 80% of patients had more than a 50% reduction of migraine. Other components of a comprehensive interdisciplinary approach include behavior modification, and lifestyle management. This could involve keeping a headache diary as well as considering diet and nutrition, exercise and trigger management.
We have a not-for-profit organization which is attached to our American Headache Society called the American Migraine Foundation. We are engaging sufferers and we are trying to create a national database—a biorepository, so that we can combine some data points and perhaps blood work and samples and history so we can really try and advance the field more on a biological basis.