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Resistant and Refractory Migraine – Two Different Entities With Different Comorbidities? Results From the Refine Study Publisher Pubmed



Rosignoli C1 ; Ornello R1 ; Caponnetto V2 ; Onofri A1 ; Avaltroni S1 ; Braschinsky M3 ; Sved O3 ; Gilgouveia R4 ; Lampl C5 ; Paungarttner J5 ; Martelletti P6 ; Wellsgatnik WD6 ; Martins IP7 ; Mitsikostas D8 Show All Authors
Authors
  1. Rosignoli C1
  2. Ornello R1
  3. Caponnetto V2
  4. Onofri A1
  5. Avaltroni S1
  6. Braschinsky M3
  7. Sved O3
  8. Gilgouveia R4
  9. Lampl C5
  10. Paungarttner J5
  11. Martelletti P6
  12. Wellsgatnik WD6
  13. Martins IP7
  14. Mitsikostas D8
  15. Apostolakopoulou L8
  16. Nabaei G9
  17. Ozge A10
  18. Narin DB10
  19. Pozorosich P11
  20. Munozvendrell A11
  21. Prudenzano MP12
  22. Gentile M12
  23. Ryliskiene K13
  24. Vainauskiene J13
  25. Del Rio MS14
  26. Vernieri F15
  27. Iaccarino G15
  28. Waliszewskaprosol M16
  29. Budrewicz S16
  30. Carnovali M17
  31. Katsarava Z17
  32. Sacco S1
Show Affiliations
Authors Affiliations
  1. 1. Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  2. 2. Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
  3. 3. Department of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
  4. 4. Headache Center, Hospital da Luz, Lisbon, Portugal
  5. 5. Headache Medical Center, Seilerstaette Linz, Linz, Austria
  6. 6. Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
  7. 7. Centro de Estudos Egas Moniz, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
  8. 8. First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
  9. 9. Iranian Center of Neurological Research, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  10. 10. Department of Neurology, Mersin University Medical Faculty, Mersin, Turkey
  11. 11. Headache Unit, Neurology Department, Vall d’Hebron University Hospital, Barcelona, Spain
  12. 12. Headache Center, Amaducci Neurological Clinic, Policlinico General Hospital, Bari, Italy
  13. 13. Center of Neurology, Vilnius University, Vilnius, Lithuania
  14. 14. Department of Neurology, Clinica Universidad de Navarra, Madrid, Spain
  15. 15. Unit of Headache and Neurosonology, Fondazione Policlinico Campus Bio-Medico and Neurology, Universita Campus Bio-Medico di Roma, Roma, Italy
  16. 16. Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
  17. 17. Department of Neurology, Christian Hospital Unna and University of Duisburg-Essen, Ruhr Metropolitan, Germany

Source: Journal of Headache and Pain Published:2024


Abstract

Background: Resistant and refractory migraine are commonly encountered in specialized headache centers. Several comorbidities, mostly psychiatric conditions, have been linked to migraine worsening; however, there is little knowledge of the comorbidity profile of individuals with resistant and refractory migraine. Methods: REFINE is a prospective observational multicenter international study involving individuals with migraine from 15 headache centers. Participants were categorized into three groups based on the European Headache Federation criteria: non-resistant and non-refractory (NRNRM), resistant (ResM), and refractory (RefM). We explored the prevalence of 20 comorbidities at baseline in the three groups. Results: Of the 689 included patients (82.8% women), 262 (38.0%) had ResM, 73 (10.4%) had RefM and 354 (51.4%) NRNRM. A higher prevalence of psychiatric comorbidities, trigger points, temporomandibular joint disorders, thyroiditis, and cerebrovascular diseases was observed in the RefM group, followed by ResM and NRNRM. Multiple comorbidities were more common in the RefM group, followed by the ResM group and by the NRNRM group (41.6% vs. 24.5% vs. 14.1% respectively; p < 0.001). At the sensitivity analysis, exploring participants with chronic migraine, significant differences among the NRNRM, ResM, and RefM groups were found in the prevalence of anxiety (p < 0.001), asthma and rhinitis (p = 0.013), bipolar and other psychiatric disorders (p = 0.049), cerebrovascular diseases (p < 0.001), depression (p < 0.001), obesity (p = 0.002), thyroiditis (p < 0.001), and trigger points (p = 0.008). Conclusion: REFINE data indicate that individuals with ResM and RefM have a higher burden of comorbidities than those with NRNRM. It can be postulated that those comorbidities may have an impact on the progression of migraine from a form that is easy to treat to a form that is resistant or refractory to treatments. Longitudinal studies are needed to understand the direction of the association between ResM or RefM and those comorbidities and if proper treatment of comorbidities might help overcome treatment resistance or refractoriness. © The Author(s) 2024.
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