How to manage chronic migraines in a 32-year-old female?

Question

Hi doctor,

A 32-year-old female presents with a five-year history of recurrent migraine headaches occurring two to three times per month.

She describes the headaches as unilateral, pulsating, and moderate to severe in intensity, often associated with nausea, photophobia, and phonophobia.

Episodes last 12 to 24 hours and sometimes disrupt her work and daily activities. She has tried over-the-counter painkillers and oral triptans with partial relief.

She reports an increase in the frequency and severity of attacks over the past six months. Her past medical history is unremarkable, and routine laboratory results are normal. She has no history of cardiovascular disease or contraindications to migraine therapy.

She is interested in preventive treatment with migraine injections, such as CGRP monoclonal antibodies, to reduce the frequency and severity of attacks.

She seeks guidance on the suitability of injection therapy, expected efficacy, potential side effects, dosing schedule, and long-term safety. She also wants advice on combining injection therapy with lifestyle modifications and acute medications for optimal migraine management.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your symptoms are typical of migraine without aura, and since the attacks are frequent and disabling, you are a good candidate for preventive (prophylactic) therapy, especially modern options like CGRP (calcitonin gene-related peptide) monoclonal antibody injections.

When migraines occur more than four to five days a month or interfere with daily life, regular preventive treatment helps reduce both the frequency and intensity of attacks.

These injections (for example, Erenumab, Fremanezumab, Galcanezumab, or Eptinezumab) target the CGRP pathway, which plays a key role in migraine pain.

Administered once monthly or, in some cases, once every three months, depending on the brand.
Most patients experience a 50 to 70 percent reduction in migraine days within two to three months.
Side effects are generally mild, including occasional injection site pain, constipation, or mild fatigue.
Considered very safe long-term, with no significant interactions with other medications.

You can continue using triptans or painkillers during acute attacks. Preventive injections are most effective when combined with regular sleep, proper hydration, balanced meals, and effective stress management. Identify and avoid triggers such as fasting, hormonal changes, bright lights, or lack of sleep.

Keep a headache diary to track the frequency, duration, and potential triggers of your headaches. Improvement is usually noticeable by the second or third month of therapy.

With CGRP therapy and a balanced lifestyle, most patients regain control over their headaches, require fewer pain medications, and experience a better quality of life.

Regular neurologist follow-ups help tailor the dose and duration of treatment as needed.

I hope this has helped you.

Please feel free to reach out to me again if you have further queries.

Thank you.