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Refractory Headaches: Historical Perspective, Need, and Purposes for an Operational Definition |
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The study of migraine has yielded many benefits for headache patients. Little
research, however, has been performed on refractory migraine headache, a term often used
interchangeably with intractable migraine. This may be a consequence of a lack of a
well-accepted definition. In a survey performed by the Refractory Headache Special Interest
Section (RHSIS) of the American Headache Society (AHS) in 2006, 58% of the members agreed
that a definition for refractory headache should be added to the International Classification
of Headache Disorders-2. A PubMed search identified 21 articles that defined refractory
or intractable headache/migraine. Sixteen defined the term "refractory" and 5 defined
the term "intractable." Many of these definitions did not address the need for an
adequate trial of a preventive medicine, disability, and medication overuse. An operational
definition will allow us to better characterize the disorder, address unmet medical needs,
and identify the most effective treatments. RHSIS of the AHS has proposed a definition of
refractory migraine. It is our hope that this definition will spur interest in this entity
and will lead to further research in the area.
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