Table 3 European Headache Federation consensus on the definitions of resistant and refractory chronic migraine (2020)

Established diagnosis of: migraine without aura and/or migraine with aura and/or chronic migraine according to ICHD-3 criteria;

Established diagnosis of: migraine without aura and/or migraine with aura and/or chronic migraine according to ICHD-3 criteria;

Debilitating headache^a for at least 8 days per month for at least 3 months;

Debilitating headache^a for at least 8 days per month for at least 6 months;

Therapeutic failure^b and/or contraindication to 3 drug classes with established evidence for migraine prevention, given at an appropriate dose and duration

Therapeutic failure^b and/or contraindication to all drug classes with established evidence for migraine prevention, given at an appropriate dose and duration

Drug classes considered for the diagnosis

 1. Antidepressants (amitriptyline, venlafaxine)

 2. Antiepileptics (valproate, topiramate)

 3. β-blockers: (propranolol, metoprolol, atenolol, timolol)

 4. Calcium channel blockers (flunarizine, cinnarizine)

 5. Drugs acting on the CGRP pathway (gepants, monoclonal antibodies)

 6. Angiotensin-converting enzyme inhibitor (lisinopril) or angiotensin receptor blocker (candesartan)

 7. Onabotulinum toxin A

 8. Other pharmacologic preventive treatments with established efficacy in migraine (any new developed drug)