Optimizing Chronic Migraine Management:
Implications of Disease Burden, Pathophysiology, Guidelines, and Clinical Trials

Please review the CME/CE information below, and click “continue” to view the activity.

Intended Audience

This activity is intended for physicians and other headache specialists interested in chronic migraine.

Statement of Need

Chronic migraine (CM) is a highly disabling neurologic disorder, with heterogeneous characteristics resulting in a range of symptom profiles, burden, and disability, that remains largely underdiagnosed and undertreated. Affecting nearly 2% of the general population, CM is one of the most disabling of the primary headache disorders, imposing considerable economic burden while interfering with social, occupational, and educational functioning; it remains an enormous challenge in neurologic and headache practices.

Treatment of CM has evolved into a multifaceted approach, including lifestyle modification, trigger management, behavioral therapy, pharmacologic therapy, education, support, management of expectations, and close follow-up. Topiramate, divalproex, and onabotulinumtoxinA have been evaluated as prophylactic treatment of CM in randomized, double-blind, placebo-controlled or active comparator-controlled trials. OnabotulinumtoxinA received approval October 15, 2010, from the US Food and Drug Administration for prophylactic treatment of CM.

This educational activity will review the pathophysiology, diagnosis, clinical practice guidelines, and optimal management of CM. In addition, faculty will discuss current clinical trials on medication overuse and CM prophylaxis.

Educational Objectives

At the conclusion of this activity, participants should be better able to:

Accreditation and Certification

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Annenberg Center for Health Sciences at Eisenhower and CogniMed Inc. The Annenberg Center is accredited by the ACCME to provide continuing medical education for physicians.

The Annenberg Center designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

There is no charge for this activity. Statements of Credit will be provided by mail following activity participation and upon completion and electronic submission of the posttest and evaluation form to CogniMed Inc. A link to the evaluation form is provided upon completion of the activity. Please allow 4 to 6 weeks for the delivery of your statement.


Richard B. Lipton, MD
Professor and Vice Chair of Neurology
Professor of Epidemiology and Population Health
Director, Montefiore Headache Center
Albert Einstein College of Medicine
Bronx, New York


Andrew C. Charles, MD
Professor and Vice Chair
Director, Headache Research and Treatment Program
Department of Neurology
David Geffen School of Medicine at UCLA
Los Angeles, California

Stephen D. Silberstein, MD
Professor of Neurology
Department of Neurology
Jefferson Medical College of Thomas Jefferson University
Director, Jefferson Headache Center
Philadelphia, Pennsylvania

Disclosure Statement

It is the policy of the Annenberg Center to ensure fair balance, independence, objectivity, and scientific rigor in all programming. All faculty and planners participating in sponsored programs are expected to identify and reference off-label product use and disclose any significant relationships with those supporting the activity or any others whose products or services are discussed. The faculty for this activity have disclosed that there will be discussion about the use of products for non–FDA-approved applications.

In accordance with the Accreditation Council for Continuing Medical Education standards, parallel documents from other accrediting bodies, and Annenberg Center policy, the following disclosures have been made:

All staff at the Annenberg Center for Health Sciences at Eisenhower have nothing to disclose.

All staff at CogniMed Inc. have nothing to disclose.

Richard B. Lipton, MD, receives research support from the National Institutes of Health, the National Headache Foundation, and the Migraine Research Fund. He is a consultant for Advanced Bionics Corporation; Allergan, Inc.; Boehringer Ingelheim; Endo Pharmaceuticals; GlaxoSmithKline; Kowa Pharmaceuticals America, Inc.; Merck & Co., Inc.; Minster Pharmaceuticals; Neuralieve Inc.; Ortho-McNeil Pharmaceutical, Inc.; and Pfizer Inc; and has received honoraria from Allergan, Inc.; GlaxoSmithKline; and Merck & Co., Inc.

Andrew C. Charles, MD, has received research support from Minster Pharmaceuticals. He serves on the advisory panels of AGA Medical Corporation; Bristol-Myers Squibb Company; Eli Lilly and Company; MAP Pharmaceuticals, Inc.; and Merck & Co., Inc.; and the speakers bureau of Merck & Co., Inc.

Stephen D. Silberstein, MD, receives research support from Advanced Neuromodulation Systems, Inc.; AGA Medical Corporation; Allergan, Inc.; Boston Scientific Corporation; Coherex Medical, Inc.; Eli Lilly and Company; Endo Pharmaceuticals Inc.; GlaxoSmithKline; MAP Pharmaceuticals, Inc.; Medtronic, Inc.; Merck & Co., Inc.; NuPathe Inc.; and Valeant Pharmaceuticals International. He is a consultant for or serves on the advisory panels or speakers bureaus of AGA Medical Corporation; Allergan, Inc.; CAPNIA Incorporated; Coherex Medical, Inc.; Endo Pharmaceuticals Inc.; GlaxoSmithKline; MAP Pharmaceuticals, Inc.; Medtronic, Inc.; Merck & Co., Inc.; NuPathe Inc.; and Valeant Pharmaceuticals International.

The ideas and opinions presented in this educational activity are those of the faculty and do not necessarily reflect the views of the Annenberg Center and/or its agents. As in all educational activities, we encourage the practitioners to use their own judgment in treating and addressing the needs of each individual patient, taking into account that patient’s unique clinical situation. The Annenberg Center disclaims all liability and cannot be held responsible for any problems that may arise from participating in this activity or following treatment recommendations presented.

This activity will address professional practice gaps in knowledge.

This program may contain discussion of investigational uses of pharmacologic and nonpharmacologic therapies. Individual clinical judgments should be used in all patient care decisions.

This symposium was not part of the American Headache Society’s® 2010 Scottsdale Headache Symposium®.

This activity is an enduring material and consists of a Web posting. Successful completion is achieved by viewing the material, reflecting on its implications in your practice, and completing the assessment component.

The estimated time to complete this activity is 1.5 hours.

This activity was originally released January 31, 2011, and is available for credit through January 31, 2012.