Peer Exchange


Chronic Migraine: New Paradigms in Management

A professionally filmed expert panel discussion focusing on the specific information and educational needs of health care professionals involved the diagnosis and treatment of chronic migraine.

Physicians discuss the role of heredity and genetic mutations in patients with chronic migraine, who predominantly report a family history of the disease.

Experts describe the multifactorial association between migraine and comorbid psychiatric disease and consider the role of neurogenic inflammation.

Panelists describe the changes that happen in the brain during the phases of migraine, reinforcing the biology of this disease that culminates in sensory amplification.

Doctors comment on the changes that occur in the brain during aura and the role of glutamate as a target, the involvement of the trigeminal vascular system, and the defective interaction of systems during migraine.

Physicians provide perspective on the unique challenges in accurately diagnosing migraine and the prevalence among headache sufferers coming into the clinic.

Panelists discuss the comorbidity of migraine and psychiatric disorders as well as the transformation of migraine from episodic to chronic.

Experts provide perspective on their approaches to discussing migraine triggers with their patients.

Panelists comment on the use of preventive therapy for patients with chronic migraine and the futility for many patients because of adverse effects and lack of efficacy.

Experts describe the 4 monoclonal antibodies against calcitonin gene-related peptide that have been studied as preventive therapy for chronic migraine.

Panelists review the favorable safety data for the recently approved monoclonal antibodies targeting calcitonin gene-related peptide (CGRP).

Experts discuss the use of monoclonal antibodies targeting calcitonin gene-related peptide as preventive therapy for migraine and the encouraging efficacy of these agents, as well as results in clinical practice that appear to surpass those seen in the phase 3 trials.

Experts review the dosage, frequency, and routes of administration for fremanezumab, erenumab, galcanezumab, and eptinezumab as preventive therapy for chronic migraine.

The experts emphasize their excitement over the recent progress in treating chronic migraine, the opportunities for developing more novel therapies, and the need for more headache specialists.

Stephen Silberstein, MD, provides an overview of what drives migraine, the evolving role of genetics, and progression from episodic to chronic disease.

The shift in preventative medicine in migraine from historically used agents to CGRP inhibitors is addressed by Stephen Silberstein, MD.

Stephen Silberstein, MD, elucidates the currently available and peripheral CGRP inhibitors in light of their indications, administration, and safety profiles.
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