In its most recent Peer Exchange panel discussion video series, NeurologyLive welcomed several experts in headache medicine to provide peer-to-peer dialogue and their authoritative insights, opinions, and perspectives on important issues facing today’s healthcare professionals treating chronic migraine.

Chronic migraine is associated with extensive disability and poor quality of life. Successful treatment often requires a multipronged approach and off-label use of older agents, and until recently, consistently safe and effective preventative therapies remained elusive. This NeurologyLive Peer Exchange discussion includes a review of the latest clinical trials and practical perspective on how the recent data apply to everyday clinical practice.

Titled “Chronic Migraine: New Paradigms in Management,” the program features Stephen D. Silberstein, MD, a professor of neurology and the director of the Jefferson Headache Center at Thomas Jefferson University, as the moderator; Peter Goadsby, MD, MBBS, PhD, DSc, a professor of neurology at both the University of California San Francisco and King’s College London; Stewart Tepper, MD, the director of the Dartmouth Headache Clinic at Dartmouth-Hitchcock Medical Center and professor of neurology at the Geisel School of Medicine at Dartmouth College; Jessica Ailani, MD, the director of the MedStar Georgetown University Hospital Headache Center; and David Dodick, MD, MS, the director of the Concussion Program, and Headache Program at Mayo Clinic.

The first segment of the series includes an in-depth look at what is known in the biology of migraine. Panelists explore the part played by genetics, migraine-associated conditions, as well as the differentiating facets of migraine with and without aura, the role of the trigeminal nerve plays, and a look into vascular theory.

Then, panelists will venture into the realm of diagnostics by laying out the challenges faced by physicians in diagnosing migraine, how it is distinguished from other primary headache disorders, and what the comorbid conditions are. Additionally, they discuss the factors that can result in a worsening of the condition or its transformation from episodic to chronic, as well as the important identifying triggers and protections.

This is followed by an extensive overview of the current options for the treatment and prevention of migraine. In this segment, panelists will assess the challenges for patients in receiving adequate treatment for chronic migraine, as well as the goals of preventive therapy and the nonpharmacologic options for treatment. This discussion is followed by a panelist assessment of the current abortive options, such as triptans and nonsteroidal anti-inflammatories, and their individual approaches with preventive medications.

Panelists will also provide recommendations for when physicians should refer their patients to peers in other areas of medicine, such as behavioral therapists, and when it is necessary to work with a specialized headache center.

That section of the Peer Exchange will be succeeded by a debate of the recently approved calcitonin gene-related peptide (CGRP) inhibitors, including the rationale for targeting CGRP and how each of the agents given the regulatory go-ahead differs. Importantly, the panelists conduct a conversation about the dosage and administration of these therapies before concluding with a discussion surrounding the investigational agents remaining in the pipeline, such as the 5-HTF1F agonists.