Practical issues of management of patients with chronic migraine. Recommendations from Russian experts

The world medicine has achieved considerable advances over the last years in understanding of causes and pathogenesis as well as in specification of diagnostics criteria and studies of therapeutic approaches at chronic migraine (CM). Meantime this widespread disease is badly recognized by the physicians and diagnosed seldom. In addition, there is no generally accepted document, regulating the treatment of patients with CM, who are peculiar by their express deadaptation due to high frequency of severe attacks of the headache (HA), co-morbid psychic and somatic disorders, frequent abuse of analgetic drugs and low adherence to preventive therapy. The specialists of our country, like in other countries, gained their own unique expertise in management of such patients, who are hard to cure, including by botulinum A toxin – representative of the state-of-the-art generation of the registered drugs with the proven efficiency against CM. The article sets out the Recommendation from the Russian specialists as to management of the patients with CM, approved by the meeting of CM Expert Board (on November 12, 2014, Moscow), including with respect to time of treatment, rules of withdrawal and replacement of drugs and some other features, in compliance with modern world concepts on pathogenesis and treatment of such disease and expertise gained in managing patients
with CM in our country.

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