The migraines have not been adequately controlled by medications or non-medication approaches (non-pharmacological). Note: This definition is drafted for the general use of patients, primary caregivers and patient advocate groups. The migraines have not been adequately controlled by medications or non-medication approaches. to include responses to abortives as well as preventive therapies – classify headaches in terms of severity and disability across the lifespan (pediatric, adult, elderly) Policy makers and patient advocacy groups.All clinicians and allied healthcare professionals.– provide a clear definition of refractory migraines for: To standardize terminology and agree on working definitions in order to: In the future, a panel of headache experts from the regional directorates of the World Headache Society will publish a consensus document. Simple would be for easy general use, and complex for research and headache specialists. To expand the current definition of refractory migraine, we would like to suggest both simple and complex definitions. In addition, other topics such as abortive medications, MOH, and a refractory scale have been included. This paper outlines the proposed definition of refractory migraine and the rationale behind the definition. We have chosen to define refractory migraine. It is also noted that current definitions focus on refractory chronic migraine. There is no scale to separate milder patients from the more severe refractory migraineurs. Moreover, the role of medication overuse headache (MOH) is unclear in current definitions. There is no mention in the current definitions of abortive approaches. 3,4,5,6,7 However, the current definition is appropriate primarily for countries where there is a wide array of treatments available, including onabotulinumtoxinA and CGRP medications. 2 Since then, a number of definitions for refractory migraines have been proposed. 1 This term was coined by Reisman in 1952.
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When an individual has persistent headaches that fail to improve after a trial of the standard treatments, the term “refractory migraine” is often used in clinical practice. The rationale behind the definitions is discussed in the subsequent sections. For countries with limited access to both preventive and abortive therapies, the patient should have failed at least half of the available preventive classes, or all of the classes of the available abortive therapies. It is suggested that refractoriness is defined as failure of adequate trials of at least 3 classes of preventives or 2 classes of abortives. The complex definition provides criteria for the categorization of responses to both abortives and preventives based on the availability of migraine treatments in different countries. These definitions include the roles of preventive and abortive medications, non-medication treatments, medication overuse headache (MOH), and a refractory scale to rate severity. Simple would be for the general use of patients and support groups, and complex for research and clinical purposes.
To expand the current description of refractory migraine, the World Headache Society advocates the use of both simple and complex definitions.
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