Chronic migraine, meaning headache on fifteen or more days a month, has treatment options the episodic form does not: onabotulinumtoxinA injections and CGRP-targeted preventives. Withdrawing an overused acute medication is frequently the necessary first step. Withdrawing an overused acute medication is frequently the necessary first step, since until that happens preventives often appear not to work.
Chronic migraine, meaning headache on fifteen or more days a month, has treatment options the episodic form does not: onabotulinumtoxinA injections and CGRP-targeted preventives. Withdrawing an overused acute medication is frequently the necessary first step. Withdrawing an overused acute medication is frequently the necessary first step, since until that happens preventives often appear not to work.
A large proportion of chronic migraine involves medication overuse headache, where frequent acute treatment has converted an episodic pattern into a near-daily one. Until that is addressed, preventives often appear not to work, and increasing them is the wrong move. Withdrawing the overused drug is done as a planned, supervised process, sometimes with bridging treatment, and headaches usually worsen temporarily before improving. Knowing that in advance is what makes it survivable.
OnabotulinumtoxinA is licensed for chronic migraine and given in cycles following a standardised injection pattern; benefit typically builds over more than one cycle. Monoclonal antibodies targeting CGRP or its receptor are given by injection at intervals and are used in both episodic and chronic migraine. Oral preventives from the beta blocker, antidepressant and anti-seizure classes remain relevant. Insurance coverage for the newer agents usually requires documented frequency and failed prior trials.
Success is fewer headache days, not zero. A shift from twenty days a month to twelve is a genuine result, and judged by feel rather than a tally it is easy to dismiss, which is how effective treatment gets abandoned. Keep a continuous calendar count. Combining a preventive with limited, tracked acute treatment is normal; what is not workable is unlimited acute use alongside a preventive, because the first undermines the second.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: migraine; American Academy of Neurology; National Institute of Neurological Disorders and Stroke.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.