Evidence map›Paper›PMID 40817153›Full record

ArticleThe journal of headache and pain2025

Longitudinal assessment of migraine burden in resistant and refractory migraine - Data from the prospective REFINE study.

Umberto Pensato, Raffaele Ornello, Chiara Rosignoli, Valeria Caponnetto, Agnese Onofri, Mark Braschinsky, Olga Sved, Raquel Gil-Gouveia, Renato Oliveira, Christian Lampl and 22 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The journal of headache and pain, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
  2. Article
  3. Observational
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

32 authors.

Umberto Pensato *Department of Neurology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, Milan, 20089, Italy.
Raffaele Ornello *Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Chiara RosignoliDepartment of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Valeria CaponnettoDepartment of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
Agnese OnofriDepartment of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Mark BraschinskyDepartment of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu and Neurology Clinic of Tartu University Hospital, Tartu, Estonia.
Olga SvedDepartment of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu and Neurology Clinic of Tartu University Hospital, Tartu, Estonia.
Raquel Gil-GouveiaHeadache Center, Neurology Department, Hospital da Luz, Lisboa, Portugal.
Renato OliveiraHeadache Center, Neurology Department, Hospital da Luz, Lisboa, Portugal.
Christian LamplHeadache Medical Center, Seilerstaette Linz, Linz, Austria.
Jakob PaungarttnerHeadache Medical Center, Seilerstaette Linz, Linz, Austria.
Paolo MartellettiUnitelma Sapienza University of Rome, Rome, Italy.
William David Wells-GatnikTexas Tech University Health Sciences Center, El Paso, TX, USA.
Isabel Pavao MartinsCentro de Estudos Egas Moniz, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
Dimos D MitsikostasFirst Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Loukia ApostolakopoulouFirst Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Aynur OzgeDepartment of Neurology, NOROM Neuroscience and Neurotechnology Center of Excellence, Mersin University Medical Faculty, Mersin, Ankara, Turkey.
Dilan Bayar NarinDepartment of Neurology, NOROM Neuroscience and Neurotechnology Center of Excellence, Mersin University Medical Faculty, Mersin, Ankara, Turkey.
Patricia Pozo-RosichHeadache Unit, Neurology Department, Headache and Neurological Pain Research Group, Vall d'Hebron University Hospital, VHIR, Barcelona, Spain.
Albert Munoz-VendrellHeadache Unit, Neurology Department, Headache and Neurological Pain Research Group, Vall d'Hebron University Hospital, VHIR, Barcelona, Spain.
Maria Pia PrudenzanoHeadache Center, Neurological Clinic, "L. Amaducci", AOUC Policlinico, Bari, Italy.
Martino GentileHeadache Center, Neurological Clinic, "L. Amaducci", AOUC Policlinico, Bari, Italy.
Kristina RyliskieneCenter of Neurology, Vilnius University, Vilnius, Lithuania.
Jurgita Vainauskiene, Kardiolitos klinikos, Vilnius, Lithuania.
Margarita Sanchez-Del-RioDepartment of Neurology, Clínica Universidad de Navarra, Madrid, Spain.
Fabrizio VernieriUnit of Headache and Neurosonology, Fondazione Policlinico Campus Bio- Medico and Neurology, Università Campus Bio-Medico di Roma, Roma, Italy.
Gianmarco IaccarinoUnit of Headache and Neurosonology, Fondazione Policlinico Campus Bio- Medico and Neurology, Università Campus Bio-Medico di Roma, Roma, Italy.
Marta Waliszewska-ProsółDepartment of Neurology, Wroclaw Medical University, Wrocław, Poland.
Sławomir BudrewiczDepartment of Neurology, Wroclaw Medical University, Wrocław, Poland.
Marta CarnovaliDepartment of Neurology, Christian Hospital Unna and University of Duisburg-Essen, Ruhr Metropolitan, Germany.
Zaza KatsaravaDepartment of Neurology, Christian Hospital Unna and University of Duisburg-Essen, Ruhr Metropolitan, Germany.
Simona SaccoDepartment of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy. simona.sacco@univaq.it.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSome individuals with migraine fail to respond adequately to preventive treatments, bearing most of migraine burden. The European Headache Federation (EHF) classifies these individuals into resistant migraine (ResM) or refractory migraine (RefM) according to treatment failures, debilitating headache days, and disease duration. We investigated the evolution of these categories over six months in patients treated at tertiary headache centers and whether they accurately reflect disability and burden.

methodsParticipants from the multicenter, prospective REFINE study were classified into three categories of treatment responsiveness, namely RefM, ResM, and non-refractory non-resistant migraine (NRNRM). The primary objective was to determine the trajectories of category changes over six months. Secondary outcomes included changes in the 6-item Headache Impact Test (HIT-6), Headache-Attributed Lost Time (HALT), and Hospital Anxiety and Depression Scale (HADS-A and HADS-D) scores.

resultsOverall, 489 participants were included with a median age of 45 years (IQR = 36-53); 389 participants (79.7%) were female; 256 (52.4%) had NRNRM, 178 (36.4%) ResM, and 55 (11.2%) RefM. At follow-up, 200/256 (78.1%) NRNRM remained stable, while 56/256 (21.9%) progressed to ResM. Among those with ResM, 98/178 (55.1%) remained stable, 72/178 (40.5%) improved to NRNRM, and 8/178 (4.5%) worsened to RefM. Among participants with RefM, 37/55 (67.3%) remained stable, while 18/55 (32.7%) improved to NRNRM. Participants with RefM and ResM presented significantly higher scores at baseline than those with NRNRM. Over time, HIT-6, HALT, and HADS-A scores improved substantially in the overall cohort (p < 0.001, p < 0.001, and p = 0.006, respectively). Improvements were observed in participants with ResM across all scores and HIT-6 and HALT for NRNRM, but no improvement was noted in participants with RefM.

conclusionsOver six months, ~ 40% of ResM and ~ 30% of RefM individuals improved to NRNRM, while ~ 20% of NRNRM developed treatment resistance after receiving care in tertiary headache centers. Participants with ResM had a better prognosis than those with RefM. While both ResM and RefM reflect high migraine disability burden, they might present relevant differences in their management and prognosis.

Indexed as

Cost of IllnessMigraine DisordersAdultFemaleHumansLongitudinal StudiesMaleMiddle AgedProspective StudiesAnti-CGRPChronic migraineDisabilityGepantsHeadacheIntractableMonoclonal antibodiesValidation

Identifiers

PMID40817153
PMCPMC12355733

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.