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What Treatments Do Migraine Specialists Offer for Chronic Migraines?

The Haven Team
July 4, 2025
•
5
min read
Women wearing Nerivo

Migraine specialists offer comprehensive treatments for chronic migraines (15+ headache days/month), including CGRP monoclonal antibodies, Botox injections, nerve blocks, infusion rescue therapy, neuromodulation devices, and lifestyle interventions, reducing monthly headache days by 50%+ through personalized protocols addressing neurogenic inflammation, medication overuse, and central sensitization. Haven Headache & Migraine Center clinicians, averaging 10 years of experience in headache medicine, deliver these evidence-based therapies through virtual consultations across California or pop-up locations, coordinating local administration for Orange County patients. Please note this article is not intended to be medical advice. Please consult a healthcare professional or schedule an appointment with Haven.

Preventive Treatments: Stop Attacks Before They Start

CGRP Monoclonal Antibodies & preventive Gpants(First-line for frequent  migraine)

  • Erenumab (Aimovig): Monthly self-injection blocking CGRP receptors
  • Fremanezumab (Ajovy): Monthly/quarterly targeting CGRP ligand
  • Galcanezumab (Emgality): Monthly neutralizing CGRP protein
  • Eptinezumab (Vyepti): Quarterly IV infusion (fastest onset)
  • Atogepant (Qulipta): Daily oral medication
  • Rimegepant (Nurtec ODT): every other day orally dissolved tablet

Depending on medication, ~50-75% of patients achieve ≥50% migraine day reduction within 1-3 months.

Botox (OnabotulinumtoxinA)
FDA-approved for chronic migraine: 155 units across 31 head/neck sites every 12 weeks. Reduces monthly headache days by 8-9 days per PREEMPT trials. Dual benefit for neck tension.

Oral Preventives (when CGRP/Botox is insufficient)
Topiramate, propranolol, and nortriptyline with specialist monitoring.

Acute and Rescue Treatments: Stop Attacks in Progress

Triptans & DHE

Gepants (CGRP receptor antagonists)

  • Rimegepant (Nurtec ODT): Acute + preventive oral tablet
  • Ubrogepant (Ubrelvy): Fast-acting acute oral treatment
  • Zavegepant (Zavzpret): Nasal spray for rapid absorption

Combination NSAID therapy & Anti-nausea

Neuromodulation Devices

  • Cefaly: External trigeminal nerve stimulator (daily 20-min sessions)
  • gammaCore: Vagus nerve stimulator for acute attacks
  • Nerivio: Remote electrical neuromodulation armband

Diagnostic and Lifestyle Interventions

Comprehensive Testing
Migraine specialists order:

  • Nutrient deficiency panels (magnesium, riboflavin, CoQ10)
  • Hormone testing (menstrual/perimenopausal triggers)
  • Sleep studies (circadian disruption)
  • Gut microbiome analysis (brain-gut axis)

Lifestyle Medicine

  • Trigger identification and elimination
  • Sleep hygiene optimization
  • Stress management (CBT, mindfulness)
  • Nutritional therapy (migraine-protective diet)

Why Haven Headache & Migraine Center Excels

Clinician Expertise
Our clinicians have an average of 10 years of experience in headache medicine with UCNS training and PA/NPs with years of headache experience.

Complete Treatment Spectrum
All FDA-approved chronic migraine therapies are available through:

  • Virtual prescribing authority
  • Strategic Orange County partner network
  • Ongoing efficacy monitoring

Note: Haven NEVER perscribes opiods or barbiturates.

Rapid Access
New patients seen within 2-3 weeks vs 6-9 months regional waits.

Insurance Coverage
In-network with most major PPO plans, TriCare, Medicare, Hill Physicians, and Brown & Toland HMO plans. HMO patients are seen on a cash basis. PPO plans include:

  • Blue Shield of California
  • Anthem
  • United Health
  • Cigna
  • Aetna
  • Humana
  • Health Net
  • Tricare
  • Medicare

Warning Signs Requiring Migraine Specialist Care

Seek specialist evaluation if:

  • Frequent headaches (4–5+ per month) cause a reduction in productivity or stop you from working or living
  • Attacks last multiple days or occur many times per month
  • The primary care provider ignores requests for help, or the medication does not restore normal function within about 2 hours
  • Your "first and worst headache" or stroke-like symptoms (go to ER or call 911 immediately)

Frequently Asked Questions

Which treatment works fastest for chronic migraines?

CGRP IV (Vyepti) shows benefits within 1 week; subcutaneous options are effective by month 1.

Can migraine specialists prescribe all therapies virtually?

Yes, Haven coordinates CGRP, Botox, and infusions through telehealth with local partners.

What if multiple treatments fail?

Combination protocols (for example, CGRP + Botox + neuromodulation) achieve success where single therapies fail.

How does Haven select the optimal treatment?

Clinicians with 10+ years of experience match therapies to your migraine pattern, comorbidities, and response history.

Are lifestyle changes enough for chronic migraines?

Lifestyle optimizes but rarely replaces advanced therapies like CGRP inhibitors for 15+ headache days/month.

Please note: This article is not intended to be medical advice. Please consult a healthcare professional or schedule an appointment with Haven.

Experience Complete Chronic Migraine Treatment

Orange County patients access Haven Headache & Migraine Center's experienced clinicians (10+ years) for all evidence-based chronic migraine therapies, virtual statewide or pop-up locations.

Start Specialized Care Today:
Haven Headache & Migraine Center

Phone: (424) 444-7399
hello@havenheadache.com

Book Consultation - Comprehensive treatment for lasting relief.

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