Migraine, far more than a simple headache, is a neurological disease characterized by intense crises that can last for several days. The pain, often throbbing and unilateral, is frequently accompanied by nausea and hypersensitivity to sensory stimuli. Some individuals experience an aura, manifesting as visual disturbances or paresthesia. A migraine is considered chronic when it occurs at least 15 days per month, with at least 8 exhibiting migraineous features.
Management involves two main approaches: acute treatment of the crisis (paracetamol, anti-inflammatories, triptans) and, for frequent or disabling cases, preventive or background treatment. The latter aims to reduce the frequency and intensity of attacks using medications such as certain beta-blockers, topiramate, amitriptyline, or candesartan.
For patients suffering from resistant migraine, recent therapeutic advancements offer hope. Treatments targeting CGRP, a key molecule in migraine mechanisms, include monoclonal antibodies administered by injection and oral treatments known as gepants. Botulinum toxin (Botox®) is also a preventive option for chronic migraine, administered according to a precise protocol.
In Belgium, access to these innovative treatments is subject to specific criteria and evaluated by a neurologist. Aquipta® (atogepant), an oral CGRP receptor blocker, is now also indicated for treating an ongoing migraine attack, offering an alternative when conventional treatments are ineffective, poorly tolerated, or contraindicated.
A novel approach from interventional neuroradiology, embolization of the middle meningeal artery, is under investigation. This procedure aims to occlude branches of this artery, implicated in headache mechanisms. Initial studies show encouraging results for refractory chronic headaches, but larger studies are needed for confirmation. The Hôpital Erasme (ULB) is collaborating between its headache and interventional neuroradiology teams to explore this avenue.