![]() Medications delivered through an IV work faster and are better absorbed. If you’re experiencing refractory migraine, here are some possible treatments: But many people with refractory migraine require treatment at a hospital, either in the emergency department or as an inpatient, so that they can access medications not available as prescriptions for home use. Some of the steps may include at-home care. Your healthcare professional should give you a migraine action plan with steps to follow if a migraine episode starts. Treating this condition can be difficult. Refractory migraine means that several traditional treatment options have already failed. How is refractory chronic migraine treated? This may also be true for refractory migraine.Īccording to a 2019 review, risk factors for progression include: Over time, they become more frequent, severe, or even chronic. That means people usually start out with occasional episodes. Migraine is often a progressive disorder. Overuse of triptans and opioid pain relievers like codeine can also cause MOH. Over-the-counter drugs such as acetaminophen and NSAIDs can cause MOH. MOH is common in people with migraine conditions, especially if they take pain relief medications more than 2 or 3 days per week. ![]() These include:Īs mentioned before, some doctors consider medication overuse to be a cause of refractory migraine, while others consider it separately. Several mental health conditions often occur with chronic migraine and may be a cause. No one knows for certain what causes some people to experience migraine, but genetics, hormones, and serotonin levels may play a role. Some experts think doctors should treat MOH and rule it out as a source of the migraine before diagnosing refractory migraine, while others disagree. But this can cause withdrawal symptoms, including headache, when the medication wears off, or they stop taking it. Some people with chronic migraine take pain relief medication almost daily to function. Medication overuse headache (MOH) has been considered.If you’ve tried things like acupuncture or biofeedback to reduce your migraine and it hasn’t helped, this also informs your diagnosis. In this case, “failure” can mean two things: the drug doesn’t reduce your migraine frequency or severity, or you can’t tolerate the drug because of side effects. There’s no consensus on how many of these treatments need to fail before you can be diagnosed with refractory migraine, but the range seems to be between two and five. Several preventive treatments aim to reduce your number of migraine episodes. In general, though, the ICHD-3 uses the term “chronic” when a person has 15 or more headache days per month, with 8 of them confirmed as migraine.ĭespite the differing criteria, a 2019 review outlines several things doctors can look for when trying to diagnose refractory chronic migraine based on ICHD guidelines: The ICHD-3 is a diagnostic manual for the treatment of migraine.Īccording to the ICHD-3, it can even be difficult to distinguish chronic migraine from episodic migraine since continuous headaches aren’t easily distinguishable from one day to the next. ![]() But the International Classification of Headache Disorders, 3rd edition (ICHD-3) is commonly used by doctors when trying to distinguish refractory migraine from other types of migraine. ![]() When does chronic migraine become refractory?Įxperts do not universally agree on the criteria for diagnosing refractory migraine.
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