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Table 2 Refractory scale (2–10, 10 = most severe)

From: Refractory chronic migraine: long-term follow-up using a refractory rating scale

1. Refractory to preventives = 2 points (refractory to preventives is determined by RHSIS [3] and Silberstein [4] criteria)

2. Refractory to abortives = 2 points (determined by RHSIS [3] and Silberstein [4] criteria)

3. Greater than 10 years of chronic migraine = 1 point (chronic migraine defined according to International Headache Society (IHS) criteria [5])

4. 25 or more days of headache per month (on average) = 1 point

5. Two of the following associated medical conditions: irritable bowel syndrome (IBS), fibromyalgia, temporal mandibular dysfunction (TMD), chronic pelvic pain, painful bladder syndrome, and chronic fatigue = 1 point. These syndromes were defined according to guidelines established by the various specialty organizations. Patients had to have been diagnosed using the standard criteria [6]

6. Psychiatric comorbidities of the following types: severe Axis I (affective disorder), or any Axis II (personality disorder) = 1 point. These were diagnosed utilizing guidelines established in DSM-IV [7]

7. Disability (work and/or home) = 1 point. The pts. had to demonstrate moderate to severe disability with poor functioning for at least 6 months. Disability was assessed by the treating physician and included interviews with the patient and family. A VAS functioning scale was utilized to aid in disability assessment

8. Medication overuse headache = 1 point. Criteria established by the IHS were utilized [5]