Refractory means “difficult to treat”…where the headaches have not responded to the usual minstrations..this is a common situation. Previously, I had published several studies(in our Archives) on long-term effects of daily headache preventives: bottom line is, only about 46% of headache patients have “long-term” success from the preventives(such as antidepressants/beta blockers/anticonvulsants, etc.). From months 6 to 15, after starting preventives, many people stop them because of declining efficacy and/or side effects.
So, what happens to these(3 million in the US) people with chronic daily headaches and no effective treatment?….I started the section of the American Headache Society 11 years ago on The Refractory Headache Patient. I have published on this(see articles on our homepage)….some of the medication approaches I employ include: long-acting opioids, frequent triptans, stimulants, MAOI’s, and Botox. However, for some nothing really works: we desperately need better and newer headache(and pain) preventives.

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