title: Refractory migraine: the role of the physician in assessment and treatment of a problematic disease.
abstract: Patients affected by chronic forms of headache are often very difficult to treat. Refractory patients are so defined when adequate trials of specific drugs (for acute or prophylactic treatment) failed both to reduce the burden of disease and to improve headache-related quality of life. An escalating approach is suggested to test different kinds of therapies. All comorbid factors should be addressed. More invasive modalities (such as neurostimulation) or promising approaches such as repetitive transcranial magnetic stimulation (rTMS) could be a future major step as third line therapies.
authors.affiliation: Department of Neurology, Headache Center and Institute of Experimental Neurology, IRCCS San Raffaele Hospital, Vita-Salute University, Via Olgettina 48, 20100 Milan, Italy. colombo.bruno@hsr.it
authors.forename: Bruno
authors.initials: B
authors.lastname: Colombo
authors.forename: Dacia
authors.initials: D
authors.lastname: Dalla Libera
authors.forename: Gloria
authors.initials: G
authors.lastname: Dalla Costa
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Comi
mesh_terms: D006801:Humans; D008881:Migraine Disorders / Q000145:classification* / Q000175:diagnosis* / Q000628:therapy*; D010148:Intractable Pain / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D010820:Physicians; D012720:Severity of Illness Index