Defining the pharmacologically intractable headache for clinical trials and clinical practice

Headache. 2010 Oct;50(9):1499-506. doi: 10.1111/j.1526-4610.2010.01764.x.


The terms refractory headache and intractable headache have been used interchangeably to describe persistent headache that is difficult to treat or fails to respond to standard and/or aggressive treatment modalities. A variety of definitions of intractability have been published, but as yet, an accepted/established definition is not available. To advance clinical and basic research in this population of patients, a universal and graded classification scheme of intractability is needed, and must include a definition of failure, to which and how many treatments the patient has failed, the level of headache-related disability, and finally, the intended intervention (clinical or research) and intensity of the intervention. This paper addresses each of these variables with the intent of providing a graded classification scheme that can be used in defining intractability for clinical practice interventions and clinical research initiatives.

Publication types

  • Review

MeSH terms

  • Analgesics / pharmacology*
  • Clinical Trials as Topic* / standards
  • Clinical Trials as Topic* / trends
  • Drug Resistance / physiology
  • Headache Disorders / classification*
  • Headache Disorders / drug therapy*
  • Headache Disorders / physiopathology
  • Humans
  • Pain, Intractable / classification*
  • Pain, Intractable / drug therapy*
  • Pain, Intractable / physiopathology
  • Practice Guidelines as Topic* / standards
  • Treatment Failure


  • Analgesics