When should "chronic migraine" patients be considered "refractory" to pharmacological prophylaxis?
Patients with chronic headache forms evolving from a previous episodic migraine ('chronic migraine') are often difficult to treat. In this paper we focus attention on aspects we believe important for producing a definition of "refractory" in relation to this headache form. We propose a "chronic migraine" patient should be considered "refractory" to pharmacological prophylaxis when adequate trials of preventive therapies at adequate doses have failed to reduce headache frequency and improve headache-related disability and, in patients with medication overuse, reduce the consumption of symptomatic drugs. However before a definition of "refractory" chronic migraine can become established, generally accepted diagnostic criteria and treatment guidelines for this condition need to be developed.
Department of Clinical Neurosciences, C. Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy. damicodo@tiscali.it
Domenico
D
D'Amico
Massimo
M
Leone
Licia
L
Grazzi
Gennaro
G
Bussone
D002908:Chronic Disease; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D055502:Secondary Prevention