When should "chronic migraine" patients be considered "refractory" to pharmacological prophylaxis?

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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.

Original languageEnglish
JournalNeurological Sciences
Issue numberSUPPL. 1
Publication statusPublished - May 2008


  • Chronic migraine (CM)
  • Prophylaxis
  • Refractory

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology


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