There are various answers and approaches to a patient with refractory chronic migraine. Firstly, it's essential to determine if the patient has already undergone multi-modality treatments, such as combining botulinum toxin injections and a CGRP mAb. While SSRIs have been mentioned, it's worth noting...

I agree with Dr. @Cohen's very measured and complete response. However, I would like to add that when a "refractory" headache presents, as with any seemingly treatment-resistant condition, it is critical to re-examine the diagnosis. It is not uncommon to find that treatment-resistant headache patien...