• Stephen D Silberstein, David W Dodick, and Starr Pearlman.
• Department of Neurology, Thomas Jefferson University, Jefferson Headache Center, 111 S. 11th Street, Philadelphia, PA 19107, USA.
• Headache. 2010 Oct 1;50(9):1499-506.

AbstractThe terms refractory headache and intractable headache have been used interchangeably to describe persistent headache that is difficult to treat or fails to respond to standard and/or aggressive treatment modalities. A variety of definitions of intractability have been published, but as yet, an accepted/established definition is not available. To advance clinical and basic research in this population of patients, a universal and graded classification scheme of intractability is needed, and must include a definition of failure, to which and how many treatments the patient has failed, the level of headache-related disability, and finally, the intended intervention (clinical or research) and intensity of the intervention. This paper addresses each of these variables with the intent of providing a graded classification scheme that can be used in defining intractability for clinical practice interventions and clinical research initiatives.© 2010 American Headache Society.

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