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. |