European headache federation consensus on the definition of resistant and refractory migraine
Abstract Introduction Despite advances in the management of headache disorders, some patients with migraine do not experience adequate pain relief with acute and preventive treatments. It is the aim of the present document to provide a definition of those migraines which are difficult-to-treat, to c...
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doaj-dca6aaca5bc747218f38a0f90cf4db9a2020-11-25T03:14:56ZengBMCThe Journal of Headache and Pain1129-23691129-23772020-06-0121111210.1186/s10194-020-01130-5European headache federation consensus on the definition of resistant and refractory migraineSimona Sacco0Mark Braschinsky1Anne Ducros2Christian Lampl3Patrick Little4Antoinette Maassen van den Brink5Patricia Pozo-Rosich6Uwe Reuter7Elena Ruiz de la Torre8Margarita Sanchez Del Rio9Alexandra J. Sinclair10Zaza Katsarava11Paolo Martelletti12Neuroscience section – Department of Applied Clinical Sciences and Biotechnology, University of L’AquilaHeadache Clinic, Department of Neurology, Tartu University ClinicsHeadache Unit, Neurology Department, Montpellier University Hospital and Montpellier UniversityDepartment of Neurology, Headache Medical Centre Linz, Hospital Barmherzige Brüder, Centre of Integrative Medicine (ZiAM) Ordensklinikum LinzEuropean Migraine & Headache Alliance (EMHA)Division of Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center RotterdamHeadache Unit, Neurology Department, Vall d’Hebron University HospitalCharité Universitätsmedizin Berlin, Department of Neurology, Charité Universitätsmedizin BerlinEuropean Migraine & Headache Alliance (EMHA)Neurology department, Clinica Universidad de NavarraMetabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of BirminghamEvangelical Hospital UnnaDepartment of Clinical and Molecular Medicine, Sapienza University of RomeAbstract Introduction Despite advances in the management of headache disorders, some patients with migraine do not experience adequate pain relief with acute and preventive treatments. It is the aim of the present document to provide a definition of those migraines which are difficult-to-treat, to create awareness of existence of this group of patients, to help Healthcare Authorities in understanding the implications, and to create a basis to develop a better pathophysiological understanding and to support further therapeutic advances. Main body Definitions were established with a consensus process using the Delphi method. Patients with migraine with or without aura or with chronic migraine can be defined as having resistant migraine and refractory migraine according to previous preventative failures. Resistant migraine is defined by having failed at least 3 classes of migraine preventatives and suffer from at least 8 debilitating headache days per month for at least 3 consecutive months without improvement; definition can be based on review of medical charts. Refractory migraine is defined by having failed all of the available preventatives and suffer from at least 8 debilitating headache days per month for at least 6 consecutive months. Drug failure may include lack of efficacy or lack of tolerability. Debilitating headache is defined as headache causing serious impairment to conduct activities of daily living despite the use of pain-relief drugs with established efficacy at the recommended dose and taken early during the attack; failure of at least two different triptans is required. Conclusions We hope, that the updated EHF definition will be able to solve the conflicts that have limited the use of definitions which have been put forward in the past. Only with a widely accepted definition, progresses in difficult-to-treat migraine can be achieved. This new definition has also the aim to increase the understanding of the impact of the migraine as a disease with all of its social, legal and healthcare implications. It is the hope of the EHF Expert Consensus Group that the proposed criteria will stimulate further clinical, scientific and social attention to patients who suffer from migraine which is difficult-to-treat.http://link.springer.com/article/10.1186/s10194-020-01130-5MigraineChronic migraineResistant migraineRefractory migraineIntractable migraine |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Simona Sacco Mark Braschinsky Anne Ducros Christian Lampl Patrick Little Antoinette Maassen van den Brink Patricia Pozo-Rosich Uwe Reuter Elena Ruiz de la Torre Margarita Sanchez Del Rio Alexandra J. Sinclair Zaza Katsarava Paolo Martelletti |
spellingShingle |
Simona Sacco Mark Braschinsky Anne Ducros Christian Lampl Patrick Little Antoinette Maassen van den Brink Patricia Pozo-Rosich Uwe Reuter Elena Ruiz de la Torre Margarita Sanchez Del Rio Alexandra J. Sinclair Zaza Katsarava Paolo Martelletti European headache federation consensus on the definition of resistant and refractory migraine The Journal of Headache and Pain Migraine Chronic migraine Resistant migraine Refractory migraine Intractable migraine |
author_facet |
Simona Sacco Mark Braschinsky Anne Ducros Christian Lampl Patrick Little Antoinette Maassen van den Brink Patricia Pozo-Rosich Uwe Reuter Elena Ruiz de la Torre Margarita Sanchez Del Rio Alexandra J. Sinclair Zaza Katsarava Paolo Martelletti |
author_sort |
Simona Sacco |
title |
European headache federation consensus on the definition of resistant and refractory migraine |
title_short |
European headache federation consensus on the definition of resistant and refractory migraine |
title_full |
European headache federation consensus on the definition of resistant and refractory migraine |
title_fullStr |
European headache federation consensus on the definition of resistant and refractory migraine |
title_full_unstemmed |
European headache federation consensus on the definition of resistant and refractory migraine |
title_sort |
european headache federation consensus on the definition of resistant and refractory migraine |
publisher |
BMC |
series |
The Journal of Headache and Pain |
issn |
1129-2369 1129-2377 |
publishDate |
2020-06-01 |
description |
Abstract Introduction Despite advances in the management of headache disorders, some patients with migraine do not experience adequate pain relief with acute and preventive treatments. It is the aim of the present document to provide a definition of those migraines which are difficult-to-treat, to create awareness of existence of this group of patients, to help Healthcare Authorities in understanding the implications, and to create a basis to develop a better pathophysiological understanding and to support further therapeutic advances. Main body Definitions were established with a consensus process using the Delphi method. Patients with migraine with or without aura or with chronic migraine can be defined as having resistant migraine and refractory migraine according to previous preventative failures. Resistant migraine is defined by having failed at least 3 classes of migraine preventatives and suffer from at least 8 debilitating headache days per month for at least 3 consecutive months without improvement; definition can be based on review of medical charts. Refractory migraine is defined by having failed all of the available preventatives and suffer from at least 8 debilitating headache days per month for at least 6 consecutive months. Drug failure may include lack of efficacy or lack of tolerability. Debilitating headache is defined as headache causing serious impairment to conduct activities of daily living despite the use of pain-relief drugs with established efficacy at the recommended dose and taken early during the attack; failure of at least two different triptans is required. Conclusions We hope, that the updated EHF definition will be able to solve the conflicts that have limited the use of definitions which have been put forward in the past. Only with a widely accepted definition, progresses in difficult-to-treat migraine can be achieved. This new definition has also the aim to increase the understanding of the impact of the migraine as a disease with all of its social, legal and healthcare implications. It is the hope of the EHF Expert Consensus Group that the proposed criteria will stimulate further clinical, scientific and social attention to patients who suffer from migraine which is difficult-to-treat. |
topic |
Migraine Chronic migraine Resistant migraine Refractory migraine Intractable migraine |
url |
http://link.springer.com/article/10.1186/s10194-020-01130-5 |
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