Defining refractory migraine: Results of the rhsis survey of american headache society members

Elliott A. Schulman, B. Lee Peterlin, Alvin E. Lake, Richard B. Lipton, Alexandra Hanlon, Sherry Siegel, Morris Levin, Peter J. Goadsby, Herbert G. Markley

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objectives. - To gauge consensus regarding a proposed definition for refractory migraine proposed by Refractory Headache Special Interest Section, and where its use would be most appropriate. Background. - Headache experts have long recognized that a subgroup of headache sufferers remains refractory to treatment. Although different groups have proposed criteria to define refractory migraine, the definition remains controversial. The Refractory Headache Special Interest Section of the American Headache Society developed a definition through a consensus process, assisted by a literature review and initial membership survey. Design. - A 12-item questionnaire was distributed at the American Headache Society meeting in 2007 during a platform session and at the Refractory Headache Special Interest Section symposium. The same questionnaire was subsequently sent to all American Headache Society members via e-mail. A total of 151 responses from AHS members form the basis of this report. The survey instrument was designed using Survey Monkey. Frequencies and percentages of the survey were used to describe survey responses. Results. - American Headache Society members agreed that a definition for refractory migraine is needed (91%) that it should be added to the International Classification of Headache Disorders-2 (86%), and that refractory forms of non-migraine headache disorders should be defined (87%). Responders believed a refractory migraine definition would be of greatest value in selecting patients for clinical drug trials. The current refractory migraine definition requires a diagnosis of migraine, interference with function or quality of life despite modification of lifestyle factors, and adequate trials of acute and preventive medicines with established efficacy. The proposed criteria for the refractory migraine definition require failing 2 preventive medications to meet the threshold for failure. Although 42% of respondents agreed with the working definition of refractory migraine, 43% favored increasing the number to 3 (50%) or 4 (26%) preventive treatment failures. When respondents were asked if they felt that the proposed definition was appropriate to select patients for invasive procedures (patent foramen ovale repair or stimulators) only 44% agreed. Conclusions. - There is a consensus for a need for a definition for refractory migraine and that it should be added to the International Classification of Headache Disorder-2. There was also general agreement by the responders that refractory forms of non-migraine headache disorders should be defined.

Original languageEnglish (US)
Pages (from-to)509-518
Number of pages10
JournalHeadache
Volume49
Issue number4
DOIs
StatePublished - Apr 2009

Fingerprint

Migraine Disorders
Headache
Headache Disorders
Consensus
Surveys and Questionnaires
Patent Foramen Ovale
Preventive Medicine
compound A 12
Postal Service
Treatment Failure
Haplorhini
Life Style
Quality of Life
Clinical Trials
Pharmaceutical Preparations

Keywords

  • Definition
  • Migraine
  • Refractory
  • Survey

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Schulman, E. A., Lee Peterlin, B., Lake, A. E., Lipton, R. B., Hanlon, A., Siegel, S., ... Markley, H. G. (2009). Defining refractory migraine: Results of the rhsis survey of american headache society members. Headache, 49(4), 509-518. https://doi.org/10.1111/j.1526-4610.2009.01370.x

Defining refractory migraine : Results of the rhsis survey of american headache society members. / Schulman, Elliott A.; Lee Peterlin, B.; Lake, Alvin E.; Lipton, Richard B.; Hanlon, Alexandra; Siegel, Sherry; Levin, Morris; Goadsby, Peter J.; Markley, Herbert G.

In: Headache, Vol. 49, No. 4, 04.2009, p. 509-518.

Research output: Contribution to journalArticle

Schulman, EA, Lee Peterlin, B, Lake, AE, Lipton, RB, Hanlon, A, Siegel, S, Levin, M, Goadsby, PJ & Markley, HG 2009, 'Defining refractory migraine: Results of the rhsis survey of american headache society members', Headache, vol. 49, no. 4, pp. 509-518. https://doi.org/10.1111/j.1526-4610.2009.01370.x
Schulman, Elliott A. ; Lee Peterlin, B. ; Lake, Alvin E. ; Lipton, Richard B. ; Hanlon, Alexandra ; Siegel, Sherry ; Levin, Morris ; Goadsby, Peter J. ; Markley, Herbert G. / Defining refractory migraine : Results of the rhsis survey of american headache society members. In: Headache. 2009 ; Vol. 49, No. 4. pp. 509-518.
@article{eb14430c02764e7b80f89f1c3c829d21,
title = "Defining refractory migraine: Results of the rhsis survey of american headache society members",
abstract = "Objectives. - To gauge consensus regarding a proposed definition for refractory migraine proposed by Refractory Headache Special Interest Section, and where its use would be most appropriate. Background. - Headache experts have long recognized that a subgroup of headache sufferers remains refractory to treatment. Although different groups have proposed criteria to define refractory migraine, the definition remains controversial. The Refractory Headache Special Interest Section of the American Headache Society developed a definition through a consensus process, assisted by a literature review and initial membership survey. Design. - A 12-item questionnaire was distributed at the American Headache Society meeting in 2007 during a platform session and at the Refractory Headache Special Interest Section symposium. The same questionnaire was subsequently sent to all American Headache Society members via e-mail. A total of 151 responses from AHS members form the basis of this report. The survey instrument was designed using Survey Monkey. Frequencies and percentages of the survey were used to describe survey responses. Results. - American Headache Society members agreed that a definition for refractory migraine is needed (91{\%}) that it should be added to the International Classification of Headache Disorders-2 (86{\%}), and that refractory forms of non-migraine headache disorders should be defined (87{\%}). Responders believed a refractory migraine definition would be of greatest value in selecting patients for clinical drug trials. The current refractory migraine definition requires a diagnosis of migraine, interference with function or quality of life despite modification of lifestyle factors, and adequate trials of acute and preventive medicines with established efficacy. The proposed criteria for the refractory migraine definition require failing 2 preventive medications to meet the threshold for failure. Although 42{\%} of respondents agreed with the working definition of refractory migraine, 43{\%} favored increasing the number to 3 (50{\%}) or 4 (26{\%}) preventive treatment failures. When respondents were asked if they felt that the proposed definition was appropriate to select patients for invasive procedures (patent foramen ovale repair or stimulators) only 44{\%} agreed. Conclusions. - There is a consensus for a need for a definition for refractory migraine and that it should be added to the International Classification of Headache Disorder-2. There was also general agreement by the responders that refractory forms of non-migraine headache disorders should be defined.",
keywords = "Definition, Migraine, Refractory, Survey",
author = "Schulman, {Elliott A.} and {Lee Peterlin}, B. and Lake, {Alvin E.} and Lipton, {Richard B.} and Alexandra Hanlon and Sherry Siegel and Morris Levin and Goadsby, {Peter J.} and Markley, {Herbert G.}",
year = "2009",
month = "4",
doi = "10.1111/j.1526-4610.2009.01370.x",
language = "English (US)",
volume = "49",
pages = "509--518",
journal = "Headache",
issn = "0017-8748",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Defining refractory migraine

T2 - Results of the rhsis survey of american headache society members

AU - Schulman, Elliott A.

AU - Lee Peterlin, B.

AU - Lake, Alvin E.

AU - Lipton, Richard B.

AU - Hanlon, Alexandra

AU - Siegel, Sherry

AU - Levin, Morris

AU - Goadsby, Peter J.

AU - Markley, Herbert G.

PY - 2009/4

Y1 - 2009/4

N2 - Objectives. - To gauge consensus regarding a proposed definition for refractory migraine proposed by Refractory Headache Special Interest Section, and where its use would be most appropriate. Background. - Headache experts have long recognized that a subgroup of headache sufferers remains refractory to treatment. Although different groups have proposed criteria to define refractory migraine, the definition remains controversial. The Refractory Headache Special Interest Section of the American Headache Society developed a definition through a consensus process, assisted by a literature review and initial membership survey. Design. - A 12-item questionnaire was distributed at the American Headache Society meeting in 2007 during a platform session and at the Refractory Headache Special Interest Section symposium. The same questionnaire was subsequently sent to all American Headache Society members via e-mail. A total of 151 responses from AHS members form the basis of this report. The survey instrument was designed using Survey Monkey. Frequencies and percentages of the survey were used to describe survey responses. Results. - American Headache Society members agreed that a definition for refractory migraine is needed (91%) that it should be added to the International Classification of Headache Disorders-2 (86%), and that refractory forms of non-migraine headache disorders should be defined (87%). Responders believed a refractory migraine definition would be of greatest value in selecting patients for clinical drug trials. The current refractory migraine definition requires a diagnosis of migraine, interference with function or quality of life despite modification of lifestyle factors, and adequate trials of acute and preventive medicines with established efficacy. The proposed criteria for the refractory migraine definition require failing 2 preventive medications to meet the threshold for failure. Although 42% of respondents agreed with the working definition of refractory migraine, 43% favored increasing the number to 3 (50%) or 4 (26%) preventive treatment failures. When respondents were asked if they felt that the proposed definition was appropriate to select patients for invasive procedures (patent foramen ovale repair or stimulators) only 44% agreed. Conclusions. - There is a consensus for a need for a definition for refractory migraine and that it should be added to the International Classification of Headache Disorder-2. There was also general agreement by the responders that refractory forms of non-migraine headache disorders should be defined.

AB - Objectives. - To gauge consensus regarding a proposed definition for refractory migraine proposed by Refractory Headache Special Interest Section, and where its use would be most appropriate. Background. - Headache experts have long recognized that a subgroup of headache sufferers remains refractory to treatment. Although different groups have proposed criteria to define refractory migraine, the definition remains controversial. The Refractory Headache Special Interest Section of the American Headache Society developed a definition through a consensus process, assisted by a literature review and initial membership survey. Design. - A 12-item questionnaire was distributed at the American Headache Society meeting in 2007 during a platform session and at the Refractory Headache Special Interest Section symposium. The same questionnaire was subsequently sent to all American Headache Society members via e-mail. A total of 151 responses from AHS members form the basis of this report. The survey instrument was designed using Survey Monkey. Frequencies and percentages of the survey were used to describe survey responses. Results. - American Headache Society members agreed that a definition for refractory migraine is needed (91%) that it should be added to the International Classification of Headache Disorders-2 (86%), and that refractory forms of non-migraine headache disorders should be defined (87%). Responders believed a refractory migraine definition would be of greatest value in selecting patients for clinical drug trials. The current refractory migraine definition requires a diagnosis of migraine, interference with function or quality of life despite modification of lifestyle factors, and adequate trials of acute and preventive medicines with established efficacy. The proposed criteria for the refractory migraine definition require failing 2 preventive medications to meet the threshold for failure. Although 42% of respondents agreed with the working definition of refractory migraine, 43% favored increasing the number to 3 (50%) or 4 (26%) preventive treatment failures. When respondents were asked if they felt that the proposed definition was appropriate to select patients for invasive procedures (patent foramen ovale repair or stimulators) only 44% agreed. Conclusions. - There is a consensus for a need for a definition for refractory migraine and that it should be added to the International Classification of Headache Disorder-2. There was also general agreement by the responders that refractory forms of non-migraine headache disorders should be defined.

KW - Definition

KW - Migraine

KW - Refractory

KW - Survey

UR - http://www.scopus.com/inward/record.url?scp=63149088937&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=63149088937&partnerID=8YFLogxK

U2 - 10.1111/j.1526-4610.2009.01370.x

DO - 10.1111/j.1526-4610.2009.01370.x

M3 - Article

C2 - 19245385

AN - SCOPUS:63149088937

VL - 49

SP - 509

EP - 518

JO - Headache

JF - Headache

SN - 0017-8748

IS - 4

ER -