Department of Neurology, Thomas Jefferson University, Jefferson Headache Center, 111 S. 11th Street, Philadelphia, PA 19107, USA.
Headache. 2010 Oct;50(9):1499-506. doi: 10.1111/j.1526-4610.2010.01764.x.
The terms refractory headache and intractable headache have been used interchangeably to describe persistent headache that is difficult to treat or fails to respond to standard and/or aggressive treatment modalities. A variety of definitions of intractability have been published, but as yet, an accepted/established definition is not available. To advance clinical and basic research in this population of patients, a universal and graded classification scheme of intractability is needed, and must include a definition of failure, to which and how many treatments the patient has failed, the level of headache-related disability, and finally, the intended intervention (clinical or research) and intensity of the intervention. This paper addresses each of these variables with the intent of providing a graded classification scheme that can be used in defining intractability for clinical practice interventions and clinical research initiatives.
难治性头痛和顽固性头痛这两个术语曾被交替使用，用来描述治疗困难或对标准和/或强化治疗方法无反应的持续性头痛。已经发表了多种关于难治性的定义，但目前尚无公认/既定的定义。为了在这类患者的临床和基础研究中取得进展，需要一种通用的、分级的难治性分类方案，该方案必须包括对失败的定义，即患者对多少种治疗方法失败，头痛相关残疾的程度，最后是干预的目的（临床或研究）和干预的强度。本文讨论了这些变量中的每一个，目的是提供一个分级分类方案，可用于定义临床实践干预和临床研究计划中的难治性。
