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The Journal of Headache and Pain

, Volume 13, Issue 3, pp 225–229

First Online: 25 February 2012Received: 08 December 2011Accepted: 07 February 2012


Refractory chronic migraine RCM is often associated with disability and a low quality of life QOL. RCM ranges in severity from mild to severe. There would be a benefit both clinically and in research use in categorizing RCM patients according to severity. This study utilized a unique RCM severity rating scale, tracking the clinical course over 10 years. A total of 129 patients, ages 19–72, were assigned a severity rating of 2–10 10 = worst. Pain level and QOL were assessed. Over the 10 years, 73% of all pts. had a 30% or more decline in pain. Pain levels improved 45% in mild pts., 42% in mod. pts., and 36% in severe pts. Pain was the same, or worse, in 4% of mild, 15% of mod., and 18% of severe pts. QOL in the mild group improved 35% over 10 years. In moderate pts., QOL improved 32%, while for the severe group QOL improved 33%. While pain and QOL improved across all three groups at the end of 10 years, the severe group remained with significantly more pain and decreased QOL than in the milder groups. The medications that helped significantly included: opioids 63% of pts. utilized opioids, frequent triptans 31%, butalbital 17%, onabotulinumtoxinA 16%, stimulants 12%, and other -various preventives- 9%. RCM pts. were rated using a refractory rating scale with the clinical course assessed over 10 years. Pain and QOL improved in all groups. In the severe group, pain and QOL improved, but still lagged behind the mild and moderate groups. Opioids and frequent triptans were the most commonly utilized meds.

KeywordsChronic migraine Refractory chronic migraine Refractory headache Chronic daily headache  Download fulltext PDF

Autor: Lawrence Robbins


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