Chronic migraine can be very exhausting and affect your quality of life. If you have chronic migraine — migraine with pain, nausea, or sensitivity to light or sound for 15 or more days per month – you’re not alone. Up to 15% of people experience migraine attacks at some point in their lives, but only between 1% and 2.2% experience chronic migraine. And while the number of people getting chronic migraine isn’t increasing, research shows that the condition is causing more disability.
The difference between treating acute migraine attacks (those that occur occasionally) and chronic migraine lies in the approach. The goal is to lower how often you get a migraine or prevent it entirely. There is a lot of ongoing chronic migraine research to find treatments for this painful condition, and more and more people are finding relief.
Treatment options have expanded, and doctors have so many more medications to try, says Kiran K.S. Bath, MD, a neurologist with Providence St. Jude Medical Center in Fullerton, California. Researchers are now studying more treatments, from ones that prevent migraine attacks from starting to “abortive” drugs that stop them as they begin.
One drug you might already know for chronic migraine prevention is onabotulinumtoxinA, or BoNT-A (Botox) injections. Botox keeps the pain messages from reaching your brain. There’s another type of FDA-approved botulinum called abobotulinumtoxinA ( Dysport). “It’s supposed to be slightly longer acting than Botox, and it’s being used to treat cervical dystonia,” Bath says. “It doesn’t have a migraine indication, so right now we’re doing a clinical trial for it and hopefully, that should be another option for our patients with chronic migraines.” Early, small studies had promising results.
The following treatments have recently been approved or are being studied now for use in chronic migraine treatment.
Atogepant
Atogepant is a drug in the anti-calcitonin gene-related peptide (CGRP) group. It was approved by the FDA in 2023 for the prevention of chronic migraine. It helps prevent blood vessels from dilating (widening), offering pain relief for some people with chronic migraine.
How is atogepant different?
Atogepant is the only anti-CGRP that’s taken by mouth (pill) and is taken daily.
The drugs in this class are the first ones to specifically prevent migraine, rather than just treat them when they happen.
How is atogepant taken?
Atogepant is available in three doses: 10 milligrams, 30 milligrams, and 60 milligrams. But for preventing chronic migraine, the dose is usually 60 milligrams, once a day. Other drugs in this class include eptinezumab, erenumab, fremanezumab, and galcanezumab. While atogepant is a pill, eptinezumab is given as an IV (into a vein) once every three months. The other drugs can be taken at home subcutaneously (just under the skin) every two or three months, depending on the drug.
Where are anti-CGRPs in the research pipeline?
Since anti-CGRPs are approved for chronic migraine, researchers are now looking at how they can help more people. There was a phase 1 study (still very early) that showed positive results for children as young as 9 years old. Researchers are also looking to see if people can take these drugs while breastfeeding.
Anti-PACAP
Pituitary adenylate cyclase-activating polypeptides (PACAPs) are antibodies that can bring on migraine attacks. Anti-PACAP is a new class of drug — not yet FDA-approved for any condition — that is being studied for the treatment of chronic migraine.
What does anti-PACAP do?
Anti-PACAPs work against PACAP to stop blood vessels from dilating, lower inflammation, and stop the pain signals from reaching your brain.
How are anti-PACAPs taken?
How the drugs are given (IV or subcutaneous) depends on which formulation of the drug is being tested and the individual studies. For example, in one particular study, the injections are given once a month for three months. The researchers are trying to find the best way to take the medications, the best doses, and how often they should be taken.
Where are anti-PACAPs in the research pipeline?
Several anti-PACAP drugs are currently in phase 2 clinical trials for chronic migraine, but none have reached phase 3 yet.
Anti-PACAP study results
Results for this class of medication are mixed. One study published in August 2025 didn’t find the infusions very effective for many patients. A current study, looking at four different doses, is ongoing and should be completed by the end of the year. Another study, published in 2024, found that these drugs might help reduce how often someone gets a migraine attack, but there were also side effects.
Other Potential Migraine Drugs
Liraglutide
Often, doctors find that medications approved for one condition are helpful for another. One such drug being studied for chronic migraine is a diabetes drug called liraglutide. It’s geared toward people who have chronic migraine as well as obesity. Very early research shows that there might be a link between pressure in the brain (intracranial pressure) and migraine. This drug lowers this pressure in people who have a condition called idiopathic intracranial hypertension (IIH). A small pilot study of 31 people has shown promise, but it’s still very early, and no phase 3 trials are underway yet.
Idebenone
Idebenone is a drug that’s currently approved for use in Europe and elsewhere to treat a rare mitochondrial condition called Leber hereditary optic neuropathy. The FDA is checking if it can approve this drug as well. Mitochondria are like the powerhouses of the cells, and when they don’t work properly, they can affect one or many body parts. Some researchers believe that this dysfunction could also trigger migraine attacks. Currently, there’s a phase 3 trial looking at idebenone, which researchers say acts like coenzyme Q10, a natural antioxidant.
Cannabis
Researchers are also looking at cannabis as a possible treatment to prevent chronic migraine. There are two phase 2 trials, one looking at using cannabis for teens (aged 14- 17 years) and the other for adults. Earlier, smaller studies found that the drug may help some people with migraine.
Two phase 2 trials are currently looking at two other possible options for chronic migraine relief: intranasal oxytocin, called TNX-1900, and tricaprilin.
Nondrug Options
Not everyone can or wants to take migraine medications, or they may have tried them and found they didn’t work. Researchers are looking at an implantable device that would disrupt the pain signals in the brain. A small pilot study reported that the low-level electrical stimulation — controlled by the patient — helped 80% of the study participants. There is a larger study going on now, and the results should be available in 2026.
Other researchers are looking at newer and better ways to disrupt the pain signals in the brain, with different types of nerve stimulation. So far, the research is very early, but there is hope.
There are some noninvasive products that might be helpful as well. Keep in mind that the FDA doesn’t approve products; they only clear them as not being likely to cause harm. This means the manufacturers haven’t put the devices through the same rigorous testing that drugs require. The products also aren’t covered by insurance, so cost might be a factor.
Mi-Helper is a portable device that is being studied now. It’s meant to help once a migraine attack starts. The tabletop device sucks in room air and cools it down. You breathe in that cooled air through a mask. Early studies show that this cooled air is helpful for some people, easing their pain without medications.
Other devices currently on the market target your nerves in different ways, and they can work well for some people. Some are applied to your head, while others are held against the neck. One is an armband.
“I’ve had decent responses for a couple of my patients,” Bath says. “For some people, it hasn’t helped at all.” Researchers are continuing to look at these devices, looking for ways to improve them, such as using smartphone technology.
But researchers are still looking at other options for noninvasive devices, such as kinetic oscillation stimulation (KOS). KOS uses a device that gently vibrates your nasal passages to affect the trigeminal system, a series of nerves in your face. An early study showed that many people who used the device had fewer headache days per month.
Participating in Clinical Trials
If you’re interested in clinical trials, the first step is to talk to your doctor. You could also check at local hospitals and clinics to see if they’re part of or know of any studies. The government website, clinicaltrials.gov, will tell you about ongoing chronic migraine trials and whether they are recruiting patients. You can type “chronic migraine” in the search area, and you’ll get a list of studies. You don’t necessarily have to live in an urban center or close to an academic facility to participate in one. Some trials allow for video check-ins, or they may have mobile clinic/study sites.
Unfortunately, not everyone is eligible for a clinical trial. Studies have strict guidelines to keep the study standardized and safe. For example, many studies say that to be eligible, you have to have tried two or three standard treatments without success, or you must be in a certain age group (this is called “failing them”).
Studies also have strict exclusion criteria, which means some things would make you unfit for a trial, like certain medical conditions. You also must have tests to make sure you’re healthy enough to take the medication. If you do get into a clinical trial, you don’t have to stay in it. You can stop taking the study drug at any time.
Takeaways
There is help available if you live with chronic migraine — and more treatments are on the way. “Just because you’ve tried some that haven’t worked for you doesn’t mean that it’s the end of the road,” Bath says. “We have many more options now.”
