How do you manage seemingly treatment-resistant chronic migraine?  

First, let's define refractory migraine. The most recent and strict diagnosis that I use was a proposal by the European Headache Federation (EHF):Refractory Migraine Established diagnosis of 1.1 Migraine without aura and/or 1.2 Migraine with aura or 1.3 Chronic migraine according to ICHD-III crit...

I agree with Dr. @Cohen's very measured and complete response. However, I would like to add that when a "refractory" headache presents, as with any seemingly treatment-resistant condition, it is critical to re-examine the diagnosis. It is not uncommon to find that treatment-resistant headache patien...

There are various answers and approaches to a patient with refractory chronic migraine. Firstly, it's essential to determine if the patient has already undergone multi-modality treatments, such as combining botulinum toxin injections and a CGRP mAb. While SSRIs have been mentioned, it's worth noting...

Typically “resistant migraine” patients have a mixture of three different types of headaches; migraines, tension headaches, and medication overuse headaches. The first step is to separate these three headaches and treat each individually. Of course, patients who come in with intractable ...