Refractory migraine is more common than you'd think — and many patients cycle through years of failed treatments before reaching the right care. A headache specialist breaks down when to refer, how to tackle medication overuse, and what's coming next in migraine treatment. The field has changed significantly over the past decade, with more targeted options than ever before.
Migraine is one of the most disabling neurological conditions out there, yet many patients spend years bouncing between providers and therapies before landing in specialized headache care. Dr. Lauren Aymen, medical director of the Headache & Facial Pain Center at the Michigan Institute for Neurological Disorders, sat down with Healio to share her approach to managing treatment-resistant migraine — from knowing when to refer to what's on the horizon.
The biggest red flags for referral? Increasing headache frequency, escalating severity, and over-reliance on acute medications. Medication overuse is a particularly sneaky culprit — exceeding 10 days/month of triptans or 15 days/month of simple analgesics can actually worsen headache frequency, creating a cycle that must be broken before any preventive therapy can be properly assessed.
Key Takeaways:
Why it matters: With more targeted, migraine-specific treatments now available, primary care providers and general neurologists have a clearer roadmap for when to escalate care — and specialists have more tools than ever to help patients who've run out of options.
