Understanding Treatment Failure and Options

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Key Questions
  • How can we differentiate between difficult-to-treat migraine, resistant migraine, and refractory migraine?
  • How common is refractory migraine?
  • What are the preventive drug classes that are considered when evaluating if someone has resistant or refractory migraine?
  • What constitutes a preventive or acute drug failure?
  • When should someone with refractory migraine go to the hospital?
  • What is the difference between refractory migraine and status migraine?
  • Why would someone have a migraine every single day?
  • Why is the long-lasting chronic migraine so difficult to treat?
  • What are the preventive and acute treatment options for someone with difficult-to-treat or refractory migraine?
  •  Why are nonpharmacological treatments not used more often to treat migraine?
Interview Notes
Simona Sacco, MD

Simona Sacco, MD

Professor of Neurology
University of L’Aquila, Italy

Simona Sacco is full professor of neurology at the University of L’Aquila in Italy. She is head of the Department of Neurology and Stroke Unit, and personally runs the local Headache Referral Center. She is treasurer of the European Headache Federation and co-editor of The Journal of Headache and Pain. Professor Sacco’s expertise is not only in headache but also in stroke. She is co-chair of the Guideline Board of the European Stroke Organization and board member of the Italian Stroke Organization. She is assistant editor of Stroke. Professor Sacco has published widely in peer-reviewed journals and elsewhere for over 20 years.

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