D'Amico Domenico, Leone Massimo, Grazzi Licia, Bussone Gennaro
Department of Clinical Neurosciences, C. Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy.
Neurol Sci. 2008 May;29 Suppl 1:S55-8. doi: 10.1007/s10072-008-0888-3.
Patients with chronic headache forms evolving from a previous episodic migraine ('chronic migraine') are often difficult to treat. In this paper we focus attention on aspects we believe important for producing a definition of "refractory" in relation to this headache form. We propose a "chronic migraine" patient should be considered "refractory" to pharmacological prophylaxis when adequate trials of preventive therapies at adequate doses have failed to reduce headache frequency and improve headache-related disability and, in patients with medication overuse, reduce the consumption of symptomatic drugs. However before a definition of "refractory" chronic migraine can become established, generally accepted diagnostic criteria and treatment guidelines for this condition need to be developed.
由先前发作性偏头痛演变而来的慢性头痛形式（“慢性偏头痛”）患者通常难以治疗。在本文中，我们将注意力集中在我们认为对于针对这种头痛形式给出“难治性”定义很重要的方面。我们提议，当以适当剂量进行的预防性治疗充分试验未能降低头痛频率、改善与头痛相关的残疾，并且对于药物过度使用的患者未能减少对症药物的消耗量时，“慢性偏头痛”患者应被视为对药物预防“难治”。然而，在“难治性”慢性偏头痛的定义确立之前，需要制定针对这种病症的普遍接受的诊断标准和治疗指南。
