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Review
When should "chronic migraine" patients be considered "refractory" to pharmacological prophylaxis?
- Domenico D'Amico, Massimo Leone, Licia Grazzi, and Gennaro Bussone.
- Department of Clinical Neurosciences, C. Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy. damicodo@tiscali.it
- Neurol. Sci. 2008 May 1;29 Suppl 1:S55-8.
AbstractPatients 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.
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