Levin Morris
Dartmouth Hitchcock Medical Center-Neurology, Lebanon, NH, USA.
Headache. 2008 Jun;48(6):783-90. doi: 10.1111/j.1526-4610.2008.01150.x.
There are a number of reasons to attempt to define and classify refractory headache disorders. Particularly important are the potential benefits in the areas of research, treatment, and medical cost reimbursement. There are challenges in attempting to classify refractory forms of headaches, including the lack of biological or other objective markers and a lack of consensus among practitioners as to what qualifies as refractoriness, or even if a separate category for refractory migraine and other refractory headaches needs to be established. A definition of refractory migraine has been proposed by Schulman et al in this issue ("Defining Refractory Migraine [RM] and Refractory Chronic Migraine [RCM]: Proposed Criteria for the Refractory Headache Special Interests Section of the American Headache Society"), which should be tested for validity and usefulness. It seems reasonable to consider adding this defined syndrome to the International Classification of Headache Disorders, second edition (ICHD-II). In this article, options for adding refractory headache syndromes to the ICHD are discussed with pros and cons for each. Two "best" options for adding the disorder "refractory migraine" to the ICHD are presented along with an illustrative case example.
尝试对难治性头痛疾病进行定义和分类有诸多原因。在研究、治疗和医疗费用报销等方面的潜在益处尤为重要。对难治性头痛形式进行分类存在挑战，包括缺乏生物学或其他客观标志物，以及从业者对于何为难治性甚至是否需要为难治性偏头痛和其他难治性头痛设立单独类别缺乏共识。舒尔曼等人在本期提出了难治性偏头痛的定义（“定义难治性偏头痛[RM]和难治性慢性偏头痛[RCM]：美国头痛协会难治性头痛特别兴趣小组的拟议标准”），应对其有效性和实用性进行检验。考虑将这一定义的综合征添加到《国际头痛疾病分类》第二版（ICHD-II）中似乎是合理的。在本文中，讨论了将难治性头痛综合征添加到ICHD中的选项，并阐述了每种选项的利弊。给出了将“难治性偏头痛”疾病添加到ICHD的两个“最佳”选项以及一个说明性病例示例。
