Refractory Chronic Migraine
by Lawrence Robbins, MD
 Refractory Chronic Migraine (RCM) results in a great deal of
disability for patients and has a huge impact on their quality of life. In order to
provide a framework for other physicians and health care providers, this author initiated
the Refractory Headache Special Interest Section of the American Headache Society. This
committee of headache specialists seeks to define a standard of diagnosis for health
practitioners and raise awareness of improved treatments for headache. Since its
inception, the committee has primarily focused on the critical area of RCM definition.
Chronic migraine (CM) is outlined in Table 1. Chronic migraine occurs in approximately 2%
of the population; we do not yet know the epidemiology or rate of occurrence of RCM. The
current pro-posed criteria for RCM are summarized in Table 2.1,2
The definition of RCM is a work in progress; the final version may be quite different
than that cited in Table 2. We may want to add modifiers as to the degree of
refractoriness (mild, moderate or severe). In some patients, RCM improves or resolves over
time, while others worsen. These situations need to be addressed in the definition.3
Challenges of Refractory Migraine3
There are a number of major challenges in dealing with RCM with each category requiring a
different approach. These include:
- What does the role of disability play, and should disability help to define RCM?
- How resistant to the myriad of treatments does one have to be?
- There is no accepted, identifiable biological marker for RCM.
- The degree of refractoriness can change over time, improving or worsening. What role
does this varying severity play?
- There are various subsets of RCM— post-traumatic headache, RCM with or without
Medication Overuse Headache (MOH), with or without major psychiatric comorbidities, etc.
Please refer to the April 2010 issue for the complete text. In the event you need to order a back issue, please click here.
— April 2010
The full article is now available as a PDF and may be
purchased for $5 and downloaded immediately:
|