Migraine is the second most common type of primary headache disorder and affects approximately 15% of the global population. Although often regarded as a benign neurological condition, migraine is associated with significant morbidity and reduced quality of life in some patients. In 2015 the Global Burden of Disease Study showed that migraine was the seventh highest cause worldwide of years lost to disability.1 Migraine is characterised by episodic, moderately-severe headache, which lasts for at least 4 hours and is typically associated with nausea, vomiting, photophobia, phonaphobia, and is exacerbated with exercise. During severe attacks patients often find it difficult to function, which can lead to significant problems at home and in the workplace. A diagnosis of chronic migraine can be made in patients who, on average, have 15 days of headache a month, for ≥3 months, of which on at least 8 days a month there are features of migraine. There is no cure for migraine, but positive changes to lifestyle and the use of migraine preventives can significantly reduce the frequency and severity of attacks. In some patients migraine preventives either fail or are not tolerated. In order to function such patients often resort to liberal use of simple analgesics, which over time may lead to the development of medication-overuse headache. A high proportion of patients referred to neurology clinics report that they do not like taking daily oral medication, which is either poorly tolerated or ineffective.Over the past 5 years there have been significant developments in the management of migraine and particularly chronic migraine. This editorial will examine the strategies that are typically adopted in a specialist headache clinic and discuss the latest treatment options, including, CBT and mindfulness training, acupuncture, the use of botulinum toxin, electrical nerve stimulation, occipital nerve blocks, and therapies …
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