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Digital Annotations: Migraines Management

D’Antona, Linda, and Manjit Matharu. “Identifying And Managing Refractory Migraine: Barriers And Opportunities?”. The Journal Of Headache And Pain, vol 20, no. 1, 2019. Springer Science And Business Media LLC,

Summary: D’Antona, Linda, and Manjit Matharu review the existing criteria and propose new criteria for classifying and diagnosing refractory migraine. The authors explore refractory migraine, which they refer to as intractable, representing a chronic disease characterized by repetitive attacks and resistance to standard treatment (D’Antona, and Matharu). The authors review the historical background of the refractory migraine and the subsequently reduced attention directed to the migraine subset. The authors also explore the epidemiology and management options for the disease. Over the decades, the characterization of refractive migraine has been faced with uncertainties and complexity due to differing characterization criteria from different organizations such as the American Headache Societies (AHS), the European Headache Federation(EHF), and different researchers (D’Antona, and Matharu). The authors note that a widely accepted definition will enable the characterization and the identification of optimum treatment of refractory migraine. The article then details some of the necessities for determining migraines’ refractoriness, such as headache diagnosis, drug treatment failure and clinical drug trials, non-pharmacological treatment failure, and disabilities attributed to the headache. The article also explores the complex pathophysiology of refractive migraine and the possible management practices. According to D’Antona and Matharu, refractive migraine remains a challenge both to the patients and clinicians (D’Antona, and Matharu).

Analysis: D’Antona, Linda, and Manjit Matharu major on chronic stubborn type of migraine and the existing complexity in identifying and managing the disease. The authors based their review on the existing inconsistencies on definition, characterization, and treatment of the intractable migraine on data from the AHS and EHF, as the main organs dealing with migraine-related diseases. D’Antona, Linda, and Manjit Matharu also detail the complexity that surrounds defining and characterizing the refractory headache and the significance of identifying a unique disease identity. The authors also support their argument by drawing the significance of previous studies. For example, the authors support that “headache characteristics, drug usage, disability status, and comorbid features are used to stage illness and triage patients to the proper level of care” (D’Antona, and Matharu). Also, the authors note the differences in terming migraine “intractable” and “refractory” according to different authors; however, the authors find the term overlapping (D’Antona, and Matharu). The article also proposes a criterion for characterizing refractory migraine by employing criteria from the International Classification of Headache Disorders and the basis of medication and drug trials from AHS and EHF. Also, D’Antona and Matharu detail the previously-preferred drugs, exacerbating factors, and comorbidities as previous studies and concerned institutions stated. Drawing from the overall complexity, the authors portray the need to standardize the currently supported data and further refinements.

Relevance: The article exposes the existing disparity in characterizing and managing repetitive and intractable migraine. The article sheds light on the underlying complexity that results in inconsistencies in diagnosis, ineffective treatments, and migraine-related deaths. The article, however, shows that there have been improvements in the research about migraines regarding characterization and treatment. Therefore, exploring more previous studies may provide data necessary to form the basis of unified characterization and treatment criteria. The article also offers study gaps from which one can draw research questions for further studies, for example, what are the manageable and non-manageable migraines? Or what interventions are promising regarding chronic and threatening migraines?


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