The Headache Center Brasil Method: A Decade of Specialized Multidisciplinary Care for Chronic Migraine

Chronic migraine with multiple previous treatment failures presents challenges that extend beyond pharmacological management. We describe the Headache Center Brasil Method, a neurologist-led multidisciplinary outpatient approach developed and progressively refined since 2016 in São Paulo, Brazil, where more than 3,000 patients have received specialized headache care. The method integrates comprehensive neurological assessment, withdrawal of conventional acute headache medications and dietary stimulants, individualized alternative oral rescue treatment, therapeutic occipital nerve blocks, preventive pharmacological treatment, and coordinated multidisciplinary interventions. An initial 12-week intensive program incorporates psychological treatment, physiotherapy, nutritional guidance, and specialized orofacial assessment. Daily telephone or digital contact during the first week and quarterly neurological consultations support longitudinal treatment coordination. Preventive treatment incorporates onabotulinumtoxinA according to the PREEMPT paradigm, with a planned minimum duration of 24 months when clinically appropriate, and combined fremanezumab in selected patients. This Perspective describes the clinical components, implementation sequence, and organizational principles of the current institutional method while distinguishing published evidence from locally developed therapeutic adaptations. It does not present patient-level outcome analyses or establish comparative effectiveness. The description provides a methodological reference for subsequent clinical research and evaluation of implementation in other specialized headache services.