Treating chronic migraine can be done acutely and preventively. There are multiple medications and integrative treatments that may be able to provide relief.

Chronic migraine is defined as migraine that occurs 15 or more days a month for 3 consecutive months. At least 8 of these days, headaches will resemble a migraine attack.

The migraine will last for 4 hours and up to 72 hours, and the pain will be moderate to severe. In addition, nausea or sensitivity to light and sound may occur.

Acute treatment is intended to provide immediate relief from migraine symptoms, while preventive treatment is meant to prevent a migraine from occurring. Along with acute and/or preventive treatment of chronic migraine, there are complementary treatments and therapies to manage coexisting conditions.

An acute treatment refers to a medication taken at the first sign of migraine. These treatments don’t prevent migraine but may offer pain relief during an episode. Most of these drugs must be taken at the first sign of migraine for best results.

The most commonly prescribed drugs for acute treatment are:

  • analgesics like nonsteroidal anti-inflammatory drugs (NSAIDs)
  • dopamine antagonists
  • ergotamines
  • ubrogepant and rimegepant
  • triptans, available as pills, injections, or nasal spray
  • dihydroergotamine, available in a nasal spray, by injection, or IV

Oral drugs targeting the CGRP pathway linked to migraine disease have emerged in recent years. Gepants and ditans used to treat chronic migraine include:

  • ubrogepant (acute treatment)
  • rimegepant (also used as a preventive treatment)
  • reyvow
  • zavegepant

Reyvow works differently than the other medications of this class. It targets serotonin receptors on the brain’s nerve endings to halt migraine attacks just as they begin. This medication can cause sedation, so driving up to 8 hours after taking it is not advised.

Newer migraine treatments may have fewer side effects than triptans and antidepressants. They’re also safe for people who have other medical conditions like a history of heart disease, stroke, or vascular diseases.

Preventive medications for chronic migraine are intended to stop migraine from occurring in the first place. Typically, this course of treatment is considered when headaches occur more than 4 days per month and other severe side effects, like debilitating auras, coincide with the headaches.

Preventive treatments include:

  • beta-blockers
  • anticonvulsants
  • antidepressants
  • onabotulinumtoxinA (injection therapy)
  • anti-CGRP monoclonal antibodies
  • Botox

The effects of most preventive migraine treatment may not kick in for 2-3 months. Your doctor may also want you to take the preventive medication for up to a year, depending on your migraine history and your body’s response to treatment. Finding the right dose is a part of the process.

Prescription medications aren’t the only source of potential relief for chronic migraine. There are some natural or integrative remedies that may help when used alongside traditional treatments.

These include:

  • aerobic exercise
  • biofeedback
  • relaxation techniques
  • cognitive therapies
  • acupuncture
  • dietary supplements like magnesium, CoQ10, butterbur, or feverfew
  • cyanocobalamin with folate and pyridoxine

Lifestyle changes may also help. Getting enough sleep, hydrating, and limiting caffeine can all provide relief from migraine symptoms.

Depression and anxiety disorders are common among people who have migraine. Research suggests that worsening depression is frequently linked to a greater risk of episodic migraine becoming chronic migraine. It’s important for doctors to evaluate and treat people with migraine for the presence of depression or anxiety.

Certain antidepressant medications have been used successfully to treat depression and reduce migraine recurrence.

One 2019 review found that serotonin-norepinephrine reuptake inhibitors (SNRIs) were shown to be effective in treating people who live with migraine and depression. But the authors said that more research is needed on the efficacy of selective serotonin reuptake inhibitors (SSRIs) in most people living with migraine and depression.

One preventive treatment for chronic migraine may also act as an antidepressant. A 2022 review found that Botox can help with mild to moderate depression. How Botox works to reduce symptoms of depression is still being determined.

Chronic migraine is treated both acutely to provide immediate relief for pain and other symptoms, and preventatively to stop migraine from occurring. While chronic migraine isn’t dangerous, it is serious due to its disruptive, often debilitating nature.

Consider keeping a migraine journal to track your migraine frequency and symptoms and what medications are or aren’t working for you. This will help your doctor find the best course of treatment.