Despite the progress made in the management of migraine, a subgroup of patients continues to experience disabling migraine symptoms that are intolerant or unresponsive to evidence-based therapies. These patients have a “refractory” or “intractable” form of migraine. Individuals who experience refractory migraine are more likely to experience high levels of disability and impaired quality of life, despite receiving optimal treatment. Understanding how refractory migraine is defined is important to determining the epidemiology and pathophysiology of the disease, identifying treatment options, determining individualized treatment selection, and substantiating the need for multidisciplinary and specialized care. At the end of this presentation, learners will be better able to understand the importance of establishing criteria for refractory migraine, understand the challenges in creating criteria for the condition, identify critical features of refractory migraine, and recognize refractory migraine in clinical practice.