I have a new article, on this homepage(upper left) on refractory(difficult to treat) headaches, a 10 year study using a unique “refractory scale”. Refractory is difficult to manage or treat, headaches that do not respond easily to the usual meds.
I would like to adapt the scale for adolescents. We see a lot of refractory headaches in kids, and separating them out into “mild, moderate, and severe refractory” would help clinically. For instance, one kid may have failed 4 preventive meds, has daily headaches, but abortives work well(Aleve, Imitrex, etc.)….and headaches for only 1 year, doing well in school, no psychiatric conditions or other medical conditions, etc.. They would be “mildly refractory”. Another sample case would be a 17y.o. young woman with severe daily headache since age 7, no preventives OR abortives work, and overlying anxiety/depression, plus fibromyalgia and TMJ, and she has not been in school for 2 years. She would be considered “Severe refractory”. Our approach is somewhat different for milder vs. severe refractory. In addition to clinically, for research patients in the milder group respond differently(more easily) than do patients int he more severe refractory group.
Creating an adolescent scale will require major tweaking of the adult refractory scale, and studies to validate this new scale.

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