Refractory migraine profile in CGRP-monoclonal antibodies scenario.

We outline that higher frequency of migraine attacks, medication overuse and pain catastrophizing characterize patients with Ref-M not responsive to CGRP-mAbs. In this frame, olanzapine effectiveness on frequency and pain intensity of migraine attacks supports the hypothesis that migraine refractoriness may be subtended by a prominent involvement of the dopaminergic pathway.