Chronic migraine is one of the most difficult conditions to manage, but new research is gradually clarifying which treatments work best.

In a major review published in the journal Annals of Internal Medicine, researchers analyzed 43 clinical studies involving adults suffering from chronic migraine — defined as headaches occurring 15 or more days per month.

The strongest evidence supported the effectiveness of a new class of medications known as CGRP-targeted therapies. These treatments reduce the number of migraine days by about two per month and are generally well tolerated by patients.

CGRP is a protein in the nervous system whose levels rise sharply during a migraine attack, triggering pain and inflammation. The new medications work by blocking this process.

These drugs are available in several forms, including injections, infusions, tablets, and even a nasal spray. Compared to older medications, they also tend to cause fewer side effects.

For comparison, botulinum toxin (Botox) may also help treat chronic migraine, but the evidence supporting its effectiveness is weaker, and side effects are more common, causing some patients to discontinue treatment.

Older medications such as topiramate, valproate, and propranolol showed even less consistent and less reliable evidence of benefit.

The authors emphasize that although the new CGRP therapies appear promising, additional independent studies are still needed, particularly regarding long-term safety and treatment accessibility.

At the same time, there is no universal solution: the choice of therapy depends on the individual patient, their condition, personal preferences, and the cost of medications.