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Table 2 European Headache Federation proposed criteria for refractory chronic migraine

From: Refractory chronic migraine: a Consensus Statement on clinical definition from the European Headache Federation

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.