Department of Neurology, Headache Unit, University Clinic of Navarra, Av, Pio XII, 36, Pamplona 31008, Spain.
BMC Neurol. 2011 Aug 1;11:94. doi: 10.1186/1471-2377-11-94.
Many migraineurs who seek care in headache clinics are refractory to treatment, despite advances in headache therapies. Epidemiology is poorly characterized, because diagnostic criteria for refractory migraine were not available until recently. We aimed to determine the frequency of refractory migraine in patients attended in the Headache Unit in a tertiary care center, according to recently proposed criteria.
The study population consisted of a consecutive sample of 370 patients (60.8% females) with a mean age of 43 years (range 14-86) evaluated for the first time in our headache unit over a one-year period (between October 2008 and October 2009). We recorded information on clinical features, previous treatments, Migraine Disability Assessment Score (MIDAS), and final diagnosis.
Overall migraine and tension-type headache were found in 46.4% and 20.5% of patients, respectively. Refractory migraine was found in 5.1% of patients. In refractory migraineurs, the mean MIDAS score was 96, and 36.8% were medication-overusers.
Refractory migraine is a relatively common and very disabling condition between the patients attended in a headache unit. The proposed operational criteria may be useful in identifying those patients who require care in headache units, the selection of candidates for combinations of prophylactic drugs or invasive treatments such as neurostimulation, but also to facilitate clinical studies in this patient group.
尽管头痛治疗方法取得了进展，但许多在头痛诊所就诊的偏头痛患者仍对治疗无反应。由于最近才出现难治性偏头痛的诊断标准，因此其流行病学特征描述不佳。我们旨在根据最近提出的标准，确定在三级保健中心头痛科就诊的患者中难治性偏头痛的频率。
研究人群包括在我们头痛科就诊的连续 370 例患者（60.8％为女性）的样本，年龄从 14 岁到 86 岁，平均年龄为 43 岁（范围 14-86 岁）。我们记录了临床特征、既往治疗、偏头痛残疾评估量表（MIDAS）和最终诊断的信息。
总体上，偏头痛和紧张型头痛分别占患者的 46.4％和 20.5％。难治性偏头痛占患者的 5.1％。在难治性偏头痛患者中，MIDAS 评分平均为 96，36.8％为药物滥用者。
难治性偏头痛是头痛科就诊患者中相对常见且非常致残的疾病。所提出的操作性标准可能有助于识别那些需要在头痛科就诊的患者，选择预防性药物联合治疗或神经刺激等侵入性治疗的候选者，也有助于对该患者组进行临床研究。
