Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Drug refractory headaches constitute an important cause of social life disability; when a lack of responsiveness to conservative treatments is ascertained for these pathological conditions, surgical options are considered. Several lines of evidence exist to assert that the neuromodulation procedures available so far are safe and effective in a large amount of patients for the treatment of different types of severe primary and secondary headaches. Central (deep-brain stimulation, DBS) and peripheral [vagus nerve stimulation (VNS), occipital nerve stimulation (ONS), subcutaneous trigeminal stimulation] neuromodulation procedures are here reviewed as reported in literature along with the experience of our Institute.
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Patients with chronic migraine are difficult to treat and often analgesic overusers. In this article attention is focused on aspects considered important for producing a definition of refractory in relation to this headache form. I propose that 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, also failed to reduce the consumption of symptomatic drugs.