From: Refractory chronic migraine: long-term follow-up using a refractory rating scale
1. Patient has diagnosis of chronic migraine (or migraine) |
2. Patient has failed adequate trial of at least two out of four drug classes |
a. Anticonvulsants |
b. Beta blockers |
c. Tricyclics |
d. Calcium channel blockers |
3. Patient has modified lifestyle and eliminated triggers |
4. Patient has failed abortive medications, including: |
a. Triptans and DHE |
b. NSAIDs and combination analgesics |
5. There may be modifiers: |
a. With or without medication overuse |
b. With significant disability |