1.3 Chronic migraine

Identification: Female patient, 38 years old, teacher, married, mother of two children.

History of Present Illness: The patient reports a history of headaches since the age of 18, initially with episodic attacks (1-2 times per month), characterized by unilateral pulsating pain of moderate to severe intensity, associated with photophobia, phonophobia, and nausea. Over the past 3 years, the attacks have become more frequent, currently occurring 20 days per month, with at least 8 days of typical migraine pain (ICHD-3 criteria for chronic migraine). The pain is disabling, significantly interfering with her daily activities and quality of life. She reports excessive use of common analgesics (paracetamol and dipyrone) and triptans (on average 15 days/month), without adequate relief.

Past Medical History: Well-controlled hypertension with losartan. Depression under treatment with sertraline for 2 years. No history of head trauma or previous surgeries.

Family History: Mother with a history of migraine without aura.

Physical and Neurological Examination: General: unremarkable. Neurological: detailed examination without focal deficits, cranial nerves intact, normal and symmetrical reflexes, preserved gait and coordination.

Complementary Investigation: Cranial MRI: normal. Laboratory tests (complete blood count, liver and renal function, TSH): within normal limits.