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

Paolo Martelletti12*, Zaza Katsarava34, Christian Lampl5, Delphine Magis6, Lars Bendtsen7, Andrea Negro1, Michael Bjørn Russell89, Dimos-Dimitrios D Mitsikostas10 and Rigmor Højland Jensen7

Author Affiliations

1 Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy

2 Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, Italy

3 Department of Neurology, Evangelical Hospital, Unna, Germany

4 Department of Neurology, University of Duisburg-Essen, Essen, Germany

5 Headache Center Seilerstaette, Department of Neurogeriatric medicine and Remobilisiation, Hospital Barmherzige Schwestern Linz, Linz, Austria

6 Department of Neurology, Headache Research Unit, University of Liège, Liège, Belgium

7 Danish Headache Center, Department of Neurology, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark

8 Head and Neck Research Group, Research Center, Akershus University Hospital, Lørenskog, Norway

9 Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway

10 Department of Neurology, Naval Hospital, Athens, Greece

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The Journal of Headache and Pain 2014, 15:47  doi:10.1186/1129-2377-15-47

Published: 28 August 2014


The debate on the clinical definition of refractory Chronic Migraine (rCM) is still far to be concluded. The importance to create a clinical framing of these rCM patients resides in the complete disability they show, in the high risk of serious adverse events from acute and preventative drugs and in the uncontrolled application of therapeutic techniques not yet validated.

The European Headache Federation Expert Group on rCM presents hereby the updated definition criteria for this harmful subset of headache disorders. This attempt wants to be the first impulse towards the correct identification of these patients, the correct application of innovative therapeutic techniques and lastly aim to be acknowledged as clinical entity in the next definitive version of the International Classification of Headache Disorders 3 (ICHD-3 beta).

Chronic migraine; Refractory chronic migraine; Disease progression; rCM classification