Table 2.
European Headache Federation proposed criteria for refractory chronic migraine
| EHF proposed criteria for refractory chronic migraine | |
|---|---|
| A. ICHD-III β chronic migraine |
|
| No medication overuse |
|
| B. Prophylactic migraine medications in adequate dosages used for at least 3 months each. |
|
| C. Contraindications or No effect of the following preventive medication with at least 3 drugs from the following classes: |
|
| • Beta blockers |
|
| propranolol up to 240 mg/d |
|
| metoprolol up to200mg |
|
| atenolol up to100mg |
|
| bisoprolol up to10mg |
|
| • Anticonvulsants |
|
| Valproate acid up to 1,5 g/d |
|
| Topiramate up to 200 mg/d |
|
| • Tricyclics |
|
| amytriptyline up to 150 mg/d |
|
| • Others |
|
| Flunarizine up to 10 mg/d |
|
| Cardesartan 16 mg/d |
|
| • OnabotulinumtoxinA |
|
| 155 - 195 U according to the PREEMPT protocol |
|
| D. Adequate treatment of psychiatric or other comorbidities by multidisciplinary team, if available. |
|
|
Notes: |
|
|
- Secondary Headache must be excluded |
|
| - MRI provides no underlying cause |
|
| - Laboratory and CSF analyses within normal range, including CSF pressure |
|
| - Meaning of efficacy: reduction on HA days >50% |
|
| - Detoxification procedure (in/out hospital setting): intravenous, oral and advice only are all accepted. |