OBJECTIVES: To understand the characteristics and management of Portuguese patients suffering from migraine who have failed two or more preventive treatments. METHODS: A worldwide, cross-sectional, online survey was conducted including migraine patients recruited via online panels and patient organizations from September 2017 to February 2018. Study participants were adults reporting 4 or more monthly migraine days over the 3 months previous to survey. Portuguese patients who have failed two or more preventive treatments were selected for this analysis. RESULTS: A total of 88 patients were included: 76.1% were female, mean age 39.5 years (range: 19-72 years), 77.3% employed and 61.4% married. More than half (52.3%) referred being affected by migraine for more than 10 years, 82.9% reported other chronic conditions (42.1% anxiety, 37.5% depression, 30.7% insomnia/ sleep disorder) and 64.8% had family history of migraine. Patients reported an average of 10.3 migraine days in the previous month (SD 7.4; range 4-31). Migraine was mainly diagnosed/treated by neurologists (57.7%/42.0%) followed by GPs (30.8%/39.8%). 45.5% of patients reported an "attack phase" duration of one or more days. Almost all participants have migraine-related sleeping difficulties (97.7%) and need long periods in darkness or isolated (93.2%; average: 12.5 hours/month; range 1-80) during a migraine attack. About 79.6% take acute medication (82.9% prescribed by doctor and 51.4% over-the-counter) namely pain relievers (81.4%), triptans (35.7%), anti-emetics (22.8%), opioids (21.4%), corticosteroids (17.1%) and ergots (14.3%). Current preventive treatments included anti-depressants (43.2%; 60.5% for +2 years), beta-blockers (25.0%; 45.5% for +2 years), anti-epileptics (31.8%; 64.3% for +2 years) among others. In 76.2% participants, preventive treatment was changed three or more times. CONCLUSIONS: This survey provides valuable insight about characteristics and management of difficult-to-treat migraine patients in Portugal and highlights unmet needs in the management of these patients that still need to be addressed.