Neurology

Migraine

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Expert Roundtables Podcast: Treatment-Resistant and Treatment-Refractory Migraine

expert roundtables by Amaal J. Starling, MD, FAAN, FAHS; Stewart J. Tepper, MD, FAHS
Overview

Treatment-resistant and treatment-refractory migraine require a careful evaluation of diagnosis, disease burden, comorbidities, and treatment response. Today’s podcast features a panel discussion on migraine biology, sensitization, earlier intervention, and treatment goals centered on restoring function.

 

References

Charles AC, Digre KB, Goadsby PJ, Robbins MS, Hershey A; American Headache Society. Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: an American Headache Society position statement update. Headache. 2024;64(4):333-341. doi:10.1111/head.14692

 

Ishii R, Schwedt TJ, Dumkrieger G, et al. Chronic versus episodic migraine: the 15-day threshold does not adequately reflect substantial differences in disability across the full spectrum of headache frequency. Headache. 2021;61(7):992-1003. doi:10.1111/head.14154

 

Pozo-Rosich P, Caronna E, Sacco S, et al. Early treatment in migraine – a call to shift prevention from attacks to disease progression: a position statement from the International Headache Society. Cephalalgia. 2025;45(10):3331024251387721. doi:10.1177/03331024251387721

 

Sacco S, Ashina M, Diener HC, et al. Setting higher standards for migraine prevention: a position statement of the International Headache Society. Cephalalgia. 2025;45(2):3331024251320608. doi:10.1177/03331024251320608

 

Sacco S, Braschinsky M, Ducros A, et al. European Headache Federation consensus on the definition of resistant and refractory migraine: developed with the endorsement of the European Migraine & Headache Alliance (EMHA). J Headache Pain. 2020;21(1):76. doi:10.1186/s10194-020-01130-5

 

Serrano D, Lipton RB, Scher AI, et al. Fluctuations in episodic and chronic migraine status over the course of 1 year: implications for diagnosis, treatment and clinical trial design. J Headache Pain. 2017;18(1):101. doi:10.1186/s10194-017-0787-1

Amaal J. Starling, MD, FAAN, FAHS

Associate Professor of Neurology
Program Director, Headache Fellowship
Program Director, Transitional Year Residency Program
Mayo Clinic College of Medicine and Science
Phoenix, AZ

Stewart J. Tepper, MD, FAHS

Vice President
New England Institute for Neurology and Headache
Stamford, CT
Professor of Neurology
Geisel School of Medicine at Dartmouth
Hanover, NH

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