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. 2020 Jun 16;21(1):76.
doi: 10.1186/s10194-020-01130-5.

European headache federation consensus on the definition of resistant and refractory migraine : Developed with the endorsement of the European Migraine & Headache Alliance (EMHA)

Simona Sacco  1   2 , Mark Braschinsky  3 , Anne Ducros  4 , Christian Lampl  5 , Patrick Little  6 , Antoinette Maassen van den Brink  7 , Patricia Pozo-Rosich  8   9 , Uwe Reuter  10 , Elena Ruiz de la Torre  6 , Margarita Sanchez Del Rio  11 , Alexandra J Sinclair  12   13 , Zaza Katsarava  14   15   16   17 , Paolo Martelletti  18   19
Affiliations

European headache federation consensus on the definition of resistant and refractory migraine : Developed with the endorsement of the European Migraine & Headache Alliance (EMHA)

Simona Sacco et al. J Headache Pain. .

Abstract

Introduction: Despite advances in the management of headache disorders, some patients with migraine do not experience adequate pain relief with acute and preventive treatments. It is the aim of the present document to provide a definition of those migraines which are difficult-to-treat, to create awareness of existence of this group of patients, to help Healthcare Authorities in understanding the implications, and to create a basis to develop a better pathophysiological understanding and to support further therapeutic advances.

Main body: Definitions were established with a consensus process using the Delphi method. Patients with migraine with or without aura or with chronic migraine can be defined as having resistant migraine and refractory migraine according to previous preventative failures. Resistant migraine is defined by having failed at least 3 classes of migraine preventatives and suffer from at least 8 debilitating headache days per month for at least 3 consecutive months without improvement; definition can be based on review of medical charts. Refractory migraine is defined by having failed all of the available preventatives and suffer from at least 8 debilitating headache days per month for at least 6 consecutive months. Drug failure may include lack of efficacy or lack of tolerability. Debilitating headache is defined as headache causing serious impairment to conduct activities of daily living despite the use of pain-relief drugs with established efficacy at the recommended dose and taken early during the attack; failure of at least two different triptans is required.

Conclusions: We hope, that the updated EHF definition will be able to solve the conflicts that have limited the use of definitions which have been put forward in the past. Only with a widely accepted definition, progresses in difficult-to-treat migraine can be achieved. This new definition has also the aim to increase the understanding of the impact of the migraine as a disease with all of its social, legal and healthcare implications. It is the hope of the EHF Expert Consensus Group that the proposed criteria will stimulate further clinical, scientific and social attention to patients who suffer from migraine which is difficult-to-treat.

Keywords: Chronic migraine; Intractable migraine; Migraine; Refractory migraine; Resistant migraine.

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Conflict of interest statement

Mark Braschinsky: Fees as a speaker or for participation to advisory boards from Abbott Laboratories, Allergan Inc., Berlin-Chemie AG (Menarini Group), Boehringer Ingelheim Pharma GmbH, Desitin Arzneimittel GmbH, EV3, Gedeon Richter Ltd., GlaxoSmithKline, KBM Pharma Ltd., H. Lundbeck A/S, Novartis Pharma Services Inc., Nycomed SEFA, Orion Pharma, Pfizer Inc., Sanofi-Aventis, Sandoz d.d., Scanmed Group, Solvay Pharmaceuticals, Teva Pharmaceutical Industries Ltd./Sicor Biotech UAB, Zentiva International. Previously consultant for H. AbbePharma GmbH, Merz Pharmaceuticals.

Anne Ducros: Fees as speaker or participation to advisory boards from Eli-Lilly, Novartis, Teva.

Zaza Katsarava: Fees as speaker or participation to advisory boards from Novartis, Lilly, TEVA, Allergan, Merck and Daiichi.

Christian Lampl: Fees as speaker or for participation to advisory boards from Allergan, Eli-Lilly, Novartis, Pfizer, Teva.

Patrick Little: none.

Paolo Martelletti: Fees as speaker or for participation to advisory boards from Allergan, Eli-Lilly, Novartis, Teva.

Antoinette Massen van den Brink: Research grant and/or speaker/consultant fees from Amgen/Novartis, Eli-Lilly, Teva.

Patricia Pozo-Rosich: Fees as consultant and speaker for Allergan, Almirall, Biohaven, Chiesi, The Corpus, Eli Lilly, Medscape, Neurodiem, Novartis and Teva. Researchh funding from Allergan, AGAUR, la Caixa foundation, Migraine Research Foundation, Instituto Investigación Carlos III, MICINN, Novartis, PERIS, ERANet Neuron; funding for clinical trials from Alder, Electrocore, Eli Lilly, Novartis and Teva.

Uwe Reuter: Fees as consultant and speaker for Allergan, Biohaven, The Corpus, Eli Lilly, Medscape, Novartis, STREAMedUP and Teva. Research funding from BMBF and Novartis, Institutional funding for clinical trials from Alder, Amgen. Allergan, Eli Lilly, Novartis and Teva.

Elena Ruiz de la Torre: none.

Simona Sacco: Fees as speaker or for participation to advisory boards from Abbott, Allergan, Eli-Lilly, Medscape, Novartis, Teva.

Margarita Sanchez Del Rio: Fees as speaker or for participation to advisory boards from Allergan, Eli-Lilly, Novartis, Teva.

Alexandra J Sinclair: Fees as speaker from Novartis and Allergan.

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