Refractory Migraines—Understanding The Unresponsive

Refractory Migraine
Refractory migraines – also known as intractable migraines – are chronic migraine headaches that do not respond to standard treatments. To be considered chronic, migraine symptoms must recur for 15 or more days per month. 

Refractory migraines are those that continue persistently despite aggressive attempts to manage them, including medical, behavioral, and alternative modes of treatment. An intractable migraine patient will find no relief from over-the-counter pain medications, prescription medications, or alternative treatments like massage and acupuncture.

If you experience refractory migraines, you are not alone. Unfortunately, these headaches are estimated to affect as many as 40,000 people in the U.S. alone, with women more likely to develop them than men. But despite the prevalence of refractory migraines, research and treatment options for the condition are still considerably limited. This is due in part to discrepancies in the definition of a refractory headache among doctors, clinicians, and researchers.

Intractable Migraine Diagnosis

It can take many months or even years for a patient to discover that he or she has been suffering from refractory migraines. Due to the nature of the condition, a diagnosis can only be made through a process of trial and error after multiple treatment options have been exhausted with little or no reduction in migraine symptoms and frequency. If you think you may suffer from refractory migraines, you will need a doctor’s diagnosis to begin pursuing advanced treatments.

According to the American Headache Society, in order to make a diagnosis of refractory migraine and recommendation for treatment, physicians must first:

  • Determine headache type – Identify whether a patient’s migraine is primary, secondary, or tertiary according to the International Classification of Headache Disorders

  • Determine disability level – Evaluate the extent of a patient’s disability in relation to his or her chronic migraine headaches. Moderate to severely disabling refractory headaches may qualify a patient for clinical trials or invasive treatment measures

  • Determine extent of treatment failure – A migraine must persist despite treatment in order to be considered refractory. Physicians must evaluate potential causes for treatment failure, such as hormone factors and drug interactions

Though the medical community is aware that refractory migraines are a problem for a significant portion of the population, there are still no clinical guidelines for diagnosing the condition. For example, a primary physician may define a refractory migraine as a recurrent migraine headache that has not responded to one or more medications. On the other hand, a specialist or clinical researcher may identify refractory migraines as those that have not responded to multiple types of treatment options, including preventative medications, triptan medications, antidepressants, and inpatient treatments.

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