Chronic Migraine Resistance: A Case Report Highlights an Overlooked Factors in Family Medicine Clinics.

Background

Chronic migraine may seem treatment-resistant when underlying medication-overuse headache (MOH) and psychosocial stressors are overlooked. This report describes a patient who was seen in a family medicine clinic with persistent triptan overuse and daily social stressors concealing the cause of her chronic headaches and highlights how pharmacologic and behavioral strategies restored control. Case presentation: A woman in her 40s with a 10-year history of migraine developed chronic daily headaches after years of near-daily eletriptan use. This persistent triptan overuse led to the failure of multiple preventive therapies during ongoing overuse. Symptom remission after eletriptan withdrawal confirmed the diagnosis of MOH. Subsequent stabilization with preventive treatment encouraging self-management and behavioral and physiotherapy interventions allowed her to achieve sustained remission and regain functional stability.

Conclusions

This case demonstrates that unrecognized medication overuse, combined with stress and unrestricted access to triptans, can mimic treatment-resistant migraine. Chronic migraine can be managed and prevented through early screening for MOH, structured patient education, multidisciplinary management approaches, and strict regulation of OTC triptan dispensing.