Abstract

Refractory headache is the most troublesome problem in headache clinic. In spite of its frequent encounter in clinical practice, the definition of "refractoriness" started to be discussed recently. Operational definition of refractory migraine and refractory chronic migraine has been suggested for clinical and basic research purpose although debates exists. Pathogenetic mechanisms of refractory headache are also being unveiled nowadays, including genetic causes and structural changes. In clinical practice, many of the patients having refractory headache might be successfully managed with basic principles. These include correct disgnosis, attention to medication-overuse or comorbid illness, proper optimized acute and preventive pharmacologic treatments, and nonpharmacological lifestyle modifications.