How do you manage seemingly treatment-resistant chronic migraine?

For example, a patient who is already on botulinum toxin injections, CGRP inhibitors, as well as an SSRI. Are there any new treatment modalities available? Is there any evidence for any kind of surgical procedures, such as deep brain stimulation?

Answer from: at Academic Institution

There are various answers and approaches to a patient with refractory chronic migraine. Firstly, it's essential to determine if the patient has already undergone multi-modality treatments, such as combining botulinum toxin injections and a CGRP mAb. While SSRIs have been mentioned, it's worth noting...

Comments

at Kaiser Permanente
I think Dr. @Cohen hits the key questions and...

Answer from: at Academic Institution

I agree with Dr. @Cohen's very measured and complete response. However, I would like to add that when a "refractory" headache presents, as with any seemingly treatment-resistant condition, it is critical to re-examine the diagnosis. It is not uncommon to find that treatment-resistant headache patien...

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How do you manage seemingly treatment-resistant chronic migraine?

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