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

Background: Chronic migraine may seem treatment-resistant when underlying medication-overuse headache (MOH) and psychosocial stressors are overlooked. This report describesa patient who was seen in a family medicine clinic with persistent triptan overuseand daily social stressors concealing the cause of her chronic headaches and highlightshow pharmacologic and behavioral strategies restored control. Case presentation: Awoman in her 40s with a 10-year history of migraine developed chronic daily headachesafter years of near-daily eletriptan use. This persistent triptan overuse led to the failure ofmultiple preventive therapies during ongoing overuse. Symptom remission after eletriptanwithdrawal confirmed the diagnosis of MOH. Subsequent stabilization with preventivetreatment encouraging self-management and behavioral and physiotherapy interventionsallowed her to achieve sustained remission and regain functional stability. Conclusions:This case demonstrates that unrecognized medication overuse, combined withstress and unrestricted access to triptans, can mimic treatment-resistant migraine. Chronicmigraine can be managed and prevented through early screening for MOH, structuredpatient education, multidisciplinary management approaches, and strict regulation ofOTC triptan dispensing.