The European Headache Federation defines refractory migraine as a condition characterized by at least eight debilitating headache days per month for a minimum of three consecutive months, despite appropriate trials of at least three classes of evidence-based preventive medications—administered at adequate doses and for sufficient duration—or when such treatments are contraindicated[1]. This definition underscores a critical clinical challenge: when standard pharmacotherapies fail, clinicians and patients face limited, often uncertain, therapeutic options.
Migraine is the second most prevalent disabling neurological disorder worldwide. It typically presents as recurrent, moderate-to-severe, unilateral, pulsating headaches, frequently accompanied by nausea, vomiting, photophobia, and phonophobia[2]. Beyond acute pain, migraine is associated with increased cardiovascular risk and substantial negative impacts on mental health, quality of life, and occupational functioning. Refractory migraine represents a particularly burdensome subset—marked by high attack frequency, prolonged duration, suboptimal response to guideline-recommended preventives, and significant functional impairment.
Despite decades of research, the precise neurobiological mechanisms underlying migraine remain incompletely understood. This knowledge gap contributes to the limited armamentarium for refractory cases. While newer agents—including calcitonin gene-related peptide (CGRP) monoclonal antibodies and gepants—have expanded treatment options, a substantial proportion of patients continue to experience inadequate control or intolerance, highlighting the need for complementary therapeutic strategies.
In Traditional Chinese Medicine (TCM), migraine is conceptualized through pattern differentiation rather than a singular disease entity. Its hallmark features—recurrent onset, unpredictable exacerbation, wind-triggered aggravation, and throbbing or migrating pain—are interpreted as manifestations of “wind pathogen,” reflecting its characteristic mobility and rapid change[3]. Within this framework, wind-dispelling herbs (“feng yao”) play a central role in restoring the smooth flow of qi, regulating spleen-stomach function (to support ascending clear yang and descending turbid yin), and directing therapeutic action to the head.
Among commonly used wind-dispelling herbs in TCM migraine management are Chuanxiong (Ligusticum chuanxiong), Bai Zhi (Angelica dahurica), Tian Ma (Gastrodia elata), and Jing Jie (Schizonepeta tenuifolia). These herbs share light, volatile, and ascending properties—key attributes for targeting the head and dispelling pathogenic wind[3].
One clinically studied formulation is Shunaixin Dripping Pills (Shu Nao Xin), a TCM product approved by China’s National Medical Products Administration for migraine attributed to blood deficiency and blood stasis syndrome. Its core ingredients—Chuanxiong and Dang Gui (Angelica sinensis)—act synergistically: Chuanxiong, acrid and warm, functions as a “qi-moving herb within the blood,” promoting circulation and ascending to the head; Dang Gui, sweet and acrid, nourishes blood, activates blood flow, and alleviates pain—earning its designation as the “supreme herb for blood disorders.” Together, they regulate qi, invigorate blood, resolve stasis, and relieve pain[4,5].
A multicenter, randomized, double-blind, controlled trial demonstrated that Shunaixin Dripping Pills significantly improved multiple clinical endpoints in patients with migraine of blood deficiency–blood stasis pattern. Compared with the control group, the treatment group showed superior outcomes in reducing headache intensity and duration, improving overall TCM syndrome scores, and ameliorating individual symptoms—including headache frequency, dizziness, insomnia, and signs of blood stasis such as cyanotic lips and nails. Importantly, no serious adverse events were reported, supporting its favorable safety profile[5].
Given the multifactorial pathophysiology of refractory migraine—including genetic susceptibility, central sensitization, neuroinflammatory pathways, and individual variations in drug metabolism—treatment must be highly personalized. Neither conventional nor TCM interventions should be self-prescribed. Clinical decision-making requires comprehensive evaluation by qualified healthcare providers, integration of diagnostic criteria, careful assessment of comorbidities and contraindications, and shared decision-making grounded in evidence and patient-centered goals.