How do you manage seemingly treatment-resistant chronic migraine?

First, let's define refractory migraine. The most recent and strict diagnosis that I use was a proposal by the European Headache Federation (EHF):

Refractory Migraine

1. Established diagnosis of 1.1 Migraine without aura and/or 1.2 Migraine with aura or 1.3 Chronic migraine according to ICHD-III criter...

I agree with Dr. @Dr. First Last'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 headac...

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...

Typically “resistant migraine” patients have a mixture of three different types of headaches; migraines, tension headaches, and medication overuse headaches. The first step is to separate these three headaches and treat each individually. Of course, patients who come in with intractable HAs must be ...