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Why headache treatment fails.

R B Lipton1, S D Silberstein, J R Saper

  • 1Department of Neurology, Albert Einstein College of Medicine, Bronx, NY10461, USA. Rlipton@aecom.yu.edu

Neurology
|April 12, 2003
PubMed
Summary
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Effective management of headache disorders requires addressing treatment failures. This article categorizes common reasons for refractory headaches, offering a structured approach for neurologists to improve patient outcomes.

Area of Science:

  • Neurology
  • Headache Medicine

Background:

  • Headache disorders are a primary cause of neurology outpatient visits.
  • Managing these conditions can be challenging, frequently leading to subspecialty referrals.

Purpose of the Study:

  • To summarize and categorize common reasons for treatment failure in headache management.
  • To provide a structured approach for neurologists to manage refractory headache patients.

Main Methods:

  • Categorization of treatment failures into five broad groups: diagnostic errors, missed exacerbating factors, inadequate pharmacotherapy, insufficient nonpharmacologic treatment, and other factors (e.g., comorbidities, unrealistic expectations).
  • Development of a checklist to aid in managing refractory headache patients.

Main Results:

Related Experiment Videos

  • Treatment failures in headache management stem from diagnostic inaccuracies, overlooked contributing factors, and suboptimal pharmacologic or nonpharmacologic therapies.
  • A systematic approach and checklist can facilitate the management of patients with refractory headaches.

Conclusions:

  • Most patients with refractory headaches have identifiable biological issues that can be addressed with accurate diagnosis and effective treatment.
  • Persistence in managing these complex cases can lead to rewarding patient outcomes.