PONOS CLINIC · SPECIALIST PAIN CARE
Resistant and refractory migraine
Reassess the treatments and the mechanisms sustaining pain.
When attacks persist despite treatment, the next step is a specialist review of the care pathway, with shared and measurable goals.
Request an assessmentThe care pathway
When treatment does not control the attacks
Frequent or disabling attacks despite treatment can affect independence, concentration and sleep. Before describing migraine as resistant, however, it is essential to establish which treatments have been tried, for how long and with what response.
Chronic
Describes the frequency of headache days according to specific diagnostic criteria.
Resistant
Describes an insufficient response to several adequately used classes of preventive treatment, with ongoing debilitating attacks.
Refractory
A more restrictive definition. Current international consensus describes refractory migraine as requiring failure of all evidence-based preventive classes available to the patient, with persistent disabling headache despite maximal appropriate treatment.
One ineffective medicine is not enough to establish resistance. Classification also takes account of intolerance, contraindications, adherence and treatment duration.
Reassess before adding another treatment
The first step is to confirm the diagnosis and investigate other causes of headache when the clinical history indicates a need. Failure of an acute medicine must be distinguished from failure of preventive treatment.
Treatment history
The medicine, dose reached, duration, benefit, adverse effects and reason for stopping help establish whether a trial was adequate.
The wider pain picture
Frequent acute medication use, sleep disorders, stress and other pain conditions may complicate the presentation and deserve specific attention.
A headache diary clarifies attack frequency, days affected by disability and medication use. Treatment changes should be agreed with your clinician.
Integrated care with measurable goals
Confirm the clinical picture
Review the diagnosis, examination, pattern of attacks and available records.
Optimise prevention
Review appropriate options with the specialist, including CGRP-targeted treatments and, for chronic migraine when indicated, botulinum toxin.
Assess selected peripheral components
Look for consistent signs of occipital neuropathy or other associated pain conditions. Not all neck pain represents a neuropathic trigger.
Review the benefit
Agree follow-up and measure headache days, function, medication use and treatment tolerability.
What role do injections and radiofrequency have?
In selected cases, a procedure may be discussed for an identifiable peripheral component. For migraine with an occipital neuropathic trigger, clinical assessment and, where appropriate, an anaesthetic block help evaluate the plausibility of the target.
A positive response to a block does not guarantee the result of radiofrequency. Procedures are not an automatic next step after medicines fail: they require an individual indication, discussion of alternatives and risks, and continuity with neurological migraine care.
Occipital nerve radiofrequency procedure · Explore chronic migraine
Frequently asked questions
One medicine did not help. Is my migraine resistant?
Not necessarily. Treatment type, dose, duration, tolerability and the number of preventive options adequately tried must be assessed.
Should I stop treatment before the appointment?
No: do not change treatment independently. Bring prescriptions, a headache diary and relevant reports for a structured review.
Does a procedure replace neurological care?
No. Any interventional treatment is integrated into specialist care and does not replace migraine diagnosis or prevention.
Review the journey so far
A useful assessment starts with the treatments you have actually tried and their impact on daily life.
Request an assessmentReferences
General information: treatment selection requires individual assessment. No outcome can be guaranteed.