European headache federation consensus on the definition of resistant and refractory migraine

The Journal of Headache and Pain

Uwe Reuter¹  Paolo Martelletti²  Christian Lampl³  Antoinette Maassen van den Brink⁴  Patrick Little⁵  Elena Ruiz de la Torre⁵  Zaza Katsarava⁶  Mark Braschinsky⁷  Anne Ducros⁸  Patricia Pozo-Rosich⁹  Alexandra J. Sinclair^1,10  Margarita Sanchez Del Rio^1,11  Simona Sacco^1,12 

[1] Charité Universitätsmedizin Berlin, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany;Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy;Regional Referral Headache Center of the Lazio region, Sant’Andrea Hospital, Rome, Italy;Department of Neurology, Headache Medical Centre Linz, Hospital Barmherzige Brüder, Centre of Integrative Medicine (ZiAM) Ordensklinikum Linz, Linz, Austria;Division of Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands;European Migraine & Headache Alliance (EMHA), Hendrik Ido Ambacht, The Netherlands;Evangelical Hospital Unna, Unna, Germany;Departmentof Neurology, University of Duisburg-Essen, Essen, Germany;EVEX Medical Corporation, Tbilisi, Georgia;IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation;Headache Clinic, Department of Neurology, Tartu University Clinics, Tartu, Estonia;Headache Unit, Neurology Department, Montpellier University Hospital and Montpellier University, Montpellier, France;Headache Unit, Neurology Department, Vall d’Hebron University Hospital, Barcelona, Spain;Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute, Department de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain;Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK;Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK;Neurology department, Clinica Universidad de Navarra, Madrid, Spain;Neuroscience section – Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio, 67100, L’Aquila, Italy;Regional Referral Headache Center of the Abruzzo region, ASL Avezzano-Sulmona-L’Aquila, L’Aquila, Italy;

关键词: Migraine;    Chronic migraine;    Resistant migraine;    Refractory migraine;    Intractable migraine;   

DOI  :  10.1186/s10194-020-01130-5

来源: Springer

【 摘 要 】

IntroductionDespite 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 bodyDefinitions 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.ConclusionsWe 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.

【 授权许可】

CC BY