Newly Proposed Diagnostic Criteria for Refractory and Resistant Migraine

The diagnosis of refractory migraine requires the failure of all evidenced-based treatment categories, according to consensus definitions developed by a panel of international headache experts. The new diagnosis criteria, which also include definitions for resistant migraine, probable refractory migraine, and migraine treatment responders, were presented at the 67th Annual Scientific Meeting of the American Headache Society (AHS). The diagnostic framework was developed to address gaps in the International Classification of Headache Disorders (ICHD-3), which does not currently include criteria for refractory migraine.

A panel of 20 experts in headache medicine and 1 facilitator executed a 5-round Delphi consensus process to review and refine the European Headache Federation (EHF) 2020 criteria for treatment-resistant migraine. Questions reaching >70% agreement were defined as consensus, with final language discussed in a concluding meeting. The effort resulted in a diagnostic framework with 4 categories:

• Refractory Migraine: For participants who have experienced the failure of all evidence-based treatment categories
• Resistant Migraine: For participants who have experienced the failure of ≥3 categories
• Probable Refractory Migraine: Used for cases with treatment access barriers (eg, areas with resource limitations, pediatric patients, issues with insurance coverage)
• Migraine Treatment Responder: A reference population for comparison in research

The authors of these criteria note that the new definitions have applications in clinical trial enrollment and treatment escalation in headache care, and they suggest that future ICHD consider the inclusion of their framework in future updates.