title: Refractory migraine in a headache clinic population.
abstract: BACKGROUND
  Many migraineurs who seek care in headache clinics are refractory to treatment, despite advances in headache therapies. Epidemiology is poorly characterized, because diagnostic criteria for refractory migraine were not available until recently. We aimed to determine the frequency of refractory migraine in patients attended in the Headache Unit in a tertiary care center, according to recently proposed criteria.
  
  
  METHODS
  The study population consisted of a consecutive sample of 370 patients (60.8% females) with a mean age of 43 years (range 14-86) evaluated for the first time in our headache unit over a one-year period (between October 2008 and October 2009). We recorded information on clinical features, previous treatments, Migraine Disability Assessment Score (MIDAS), and final diagnosis.
  
  
  RESULTS
  Overall migraine and tension-type headache were found in 46.4% and 20.5% of patients, respectively. Refractory migraine was found in 5.1% of patients. In refractory migraineurs, the mean MIDAS score was 96, and 36.8% were medication-overusers.
  
  
  CONCLUSIONS
  Refractory migraine is a relatively common and very disabling condition between the patients attended in a headache unit. The proposed operational criteria may be useful in identifying those patients who require care in headache units, the selection of candidates for combinations of prophylactic drugs or invasive treatments such as neurostimulation, but also to facilitate clinical studies in this patient group.
authors.affiliation: Department of Neurology, Headache Unit, University Clinic of Navarra, Av, Pio XII, 36, Pamplona 31008, Spain. pirimia@unav.es
authors.forename: Pablo
authors.initials: P
authors.lastname: Irimia
authors.forename: Jose-Alberto
authors.initials: JA
authors.lastname: Palma
authors.forename: Roberto
authors.initials: R
authors.lastname: Fernandez-Torron
authors.forename: Eduardo
authors.initials: E
authors.lastname: Martinez-Vila
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003027:Cluster Headache / Q000175:diagnosis; D005260:Female; D006261:Headache / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D010148:Intractable Pain / Q000175:diagnosis*; D055815:Young Adult