Why headache treatment fails

Richard B. Lipton, S. D. Silberstein, J. R. Saper, M. E. Bigal, P. J. Goadsby

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Management of headache disorders, a leading reason for neurologic outpatient visits, is often difficult. In this article, the authors summarize and categorize the common reasons for treatment failure leading to referral to subspecial headache centers. They have grouped these treatment failures into five broad categories: 1) the diagnosis is incomplete or incorrect; 2) important exacerbating factors have been missed; 3) pharmacotherapy has been inadequate; 4) nonpharmacologic treatment has been inadequate; 5) other factors, including unrealistic expectations and comorbidity, exist. The authors present an orderly approach to treatment failure to assist neurologists in managing difficult patients. Most refractory headache patients have a biologically determined problem and can be helped by accurate diagnosis or effective treatment. Persistence in treating these patients can be very rewarding. The authors provide a checklist intended to facilitate the management of refractory patients.

Original languageEnglish (US)
Pages (from-to)1064-1070
Number of pages7
JournalNeurology
Volume60
Issue number7
StatePublished - Apr 8 2003

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Headache
Treatment Failure
Headache Disorders
Therapeutics
Checklist
Nervous System
Comorbidity
Outpatients
Referral and Consultation
Drug Therapy

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Lipton, R. B., Silberstein, S. D., Saper, J. R., Bigal, M. E., & Goadsby, P. J. (2003). Why headache treatment fails. Neurology, 60(7), 1064-1070.

Why headache treatment fails. / Lipton, Richard B.; Silberstein, S. D.; Saper, J. R.; Bigal, M. E.; Goadsby, P. J.

In: Neurology, Vol. 60, No. 7, 08.04.2003, p. 1064-1070.

Research output: Contribution to journalArticle

Lipton, RB, Silberstein, SD, Saper, JR, Bigal, ME & Goadsby, PJ 2003, 'Why headache treatment fails', Neurology, vol. 60, no. 7, pp. 1064-1070.
Lipton RB, Silberstein SD, Saper JR, Bigal ME, Goadsby PJ. Why headache treatment fails. Neurology. 2003 Apr 8;60(7):1064-1070.
Lipton, Richard B. ; Silberstein, S. D. ; Saper, J. R. ; Bigal, M. E. ; Goadsby, P. J. / Why headache treatment fails. In: Neurology. 2003 ; Vol. 60, No. 7. pp. 1064-1070.
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