What You Should Know About Refractory Chronic Migraines

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Do you feel like you have tried every medication to treat your migraines and nothing works? If so, you are not alone – and you may be suffering from refractory chronic migraine.

Let's examine what refractory chronic migraine is and what scientists are doing to better understand this condition.

Meaning of Refractory

Refractory refers to a lack of response to treatment – so people with refractory migraines do not get relief from acute migraine therapies, and they continue to develop migraines despite preventive migraine therapy.

Also, for people with refractory chronic migraines, their headaches severely impact their quality of life and daily functioning.

According to the International Headache Society, a chronic migraine occurs on 15 or more days per month for at least 3 months.

How the Diagnosis Criteria Was Defined

In 2008, the Refractory Headache Special Interest Section (RHSIS) and the American Headache Society (AHS) set out to define criteria for refractory chronic migraine. Since then, other researchers have proposed definitions – as there is debate over how to precisely define "refractory."

Types of Medications That Do Not Aid Refractory Chronic Migraine Patients

Preventive

According to the definition proposed by the RHSIS and AHS, people with refractory chronic migraine continue to have migraines despite trying at least 2 of the 4 preventive migraine medications:

Abortive

According to the definition proposed by the RHSIS and AHS, people with refractory chronic migraines continue to have migraines despite trying the following abortive migraine medications – assuming they are not allergic or have some other contraindication to taking the drug.

  • Both a triptan and dihydroergotamine (DHE) intranasal or injectable
  • Either a nonsteroidal anti-inflammatory (NSAID) or combination pain-alleviating medications ( e.g., acetaminophen/aspirin/caffeine or Excedrin Migraine)

Continuing to Evolve the Definition

The European Headache Federation (EHF) is redefining refractory chronic migraine. They want to clarify and expand on prior definitions in hopes that this creates a more clear, widespread, and consistent definition to be utilized in future research studies.

One of the points EHF wants to include is having a person with chronic migraine try onabotulinumtoxinA (Botox) as a preventive strategy – before being identified as refractory.

They also want to include specific and appropriate dosages of migraine preventive medications – as sometimes people take a medication at a dose that is too low to really be effective, and then labeled as "not working" or "failed" by the doctor.

What Patients Can Do

If you suffer from refractory chronic migraines, try not to be discouraged. Seek guidance from your headache specialist or neurologist on novel therapies – like Botox – and remain proactive in your care and ​ability to cope.​

Sources

Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders: 2nd Edition". Cephalalgia 2004;24 Suppl 1:9-160.

Martellett P et al. Refractory chronic migraine: a consensus statement on clinical definition from the European Headache Federation. J Headache Pain. 2014 Aug 28;15:47.

Schulman EA et al. Defining refractory migraine and refractory chronic migraine: proposed criteria from the Refractory Headache Special Interest Section of the American Headache Society. Headache. 2008;48:778-82.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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