GuideLine Implementability Appraisal (GLIA). Pay attention to lifestyle and specific migraine triggers in order to reduce the frequency of attacks. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. Occasionally new recommendations were generated from parking lot item discussions. Before trying complementary or alternative therapy, discuss the risks and benefits with your doctor. Then in 2004, the International Headache Society published the International Classification of Headache Disorders; 2nd Edition (ICHD-II). We also thank Ms Wendy McIndoo for administrative assistance and Ms Liz Dennett and Ms Dagmara Chojecki for information services support. Chronic daily headache (CDH) is a descriptive term that encompasses several different specific headache diagnoses characterized by frequent headaches. Imaging should be considered if red flags are present.7 The most useful test is magnetic resonance imaging (MRI), which is more sensitive than computed tomography for detecting many secondary causes of chronic daily headache. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. It is important to work with patients to change the type, dosing, or timing of pharmacotherapy to maximize compliance and help prevent overuse of abortive therapies. Yancey JR, et al. Director of Health Technology Assessment at the Institute of Health Economics. Graud G, Lantri-Minet M, Lucas C, Valade D, French Society for the Study of Migraine Headache (SFEMC) French guidelines for the diagnosis and management of migraine in adults and children. In response to this development, the "Clinical Practice Guideline for Ch. AGREE II: advancing guideline development, reporting and evaluation in healthcare. The guideline adaptation process precluded an in-depth analysis of the validity or a formal assessment of the strength and quality of the underlying empirical evidence, which made categorizing the strength and type of recommendations problematic. Chronic daily headache and chronic migraine. International Headache Society published the International Classification of Headache Disorders 2nd Edition (ICHDII) in 2004. Do not do imaging for uncomplicated headache. Shiffman RN, Dixon J, Brandt C, Essaihi A, Hsiao A, Michel G, et al. Unless side effects mandate discontinuation, continue the prophylactic drug for at least 68 wk after dose titration is completed, Because migraine attack tendency fluctuates over time, consider gradual discontinuation of the drug for many patients after 6 to 12 mo of successful prophylactic therapy, but preventive medications can be continued for much longer in patients who have experienced substantial migraine-related disability, Consider a diagnosis of medication overuse headache in patients with headache on 15 d/mo and assess patients for possible medication overuse (use of triptans, ergots, combination analgesics, or opioid-containing medications on 10 d/mo, or use of acetaminophen or NSAIDs on 15 d/mo). The AGREE Collaboration Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Chronic migraines occur in patients with a history of migraines who have a rapid or gradual progression to chronic daily headache. This necessitates at least half a year of headache history, a concept that is often unacceptable to the patient and family physician. Discordant recommendations were highlighted in the tables. Lifestyle factors to avoid include the following: Use acute pharmacologic therapy for individual attacks, Use prophylactic pharmacologic therapy, when indicated, to reduce attack frequency, Evaluate and treat coexistent medical and psychiatric disorders. A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. Preventive prescription medications for migraine are offered in many forms such as tablets, nasal sprays and injections. Chronic daily headache: An overview. headache specialists. When you're ready to begin preventive therapy, your doctor may recommend: Antidepressants. Careers. Coenzyme Q10 supplements might be helpful in some individuals. Herbs, vitamins and minerals. This article is eligible for Mainpro-M1 credits. All rights reserved. Her vital signs and appearance are unremarkable, and the results of her neurologic examination are normal. However, these issues were overcome by using credible seed guidelines, scrupulously listing the evidence type and source for all recommendations, and clearly documenting the subjective contextualization process. Scottish Intercollegiate Guidelines Network . Rather than relying on medication as a main coping strategy, patients with suspected medication overuse might benefit from training in and development of more adaptive self-management strategies (eg, identification and management of controllable headache triggers, relaxation exercises, effective stress management skills, and activity pacing), Headache diaries that record acute medication intake are important in the prevention and treatment of medication-overuse headache, Patient education. What, if anything, seems to improve your headaches? Types of Migraine What websites do you recommend? Not all complementary or alternative therapies have been studied as headache treatments, and others need further research. Ambassador program guideline for management of primary headache in adults: background document. To avoid rebound headaches, don't take these more than three times a week. Adjunct Clinical Assistant Professor in the Faculty of Medicine at the University of Calgary. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. Consider early specialist referral. Hazard E, Munakata J, Bigal ME, Rupnow MF, Lipton RB. A series of companion documents were created, adapted, or adopted to support the implementation of the guideline. The seed guidelines are listed in Table 1.2331 The Alberta guidelines 91 recommendations are organized into 6 sections. Background Quality clinical trials form an essential part of the evidence base for the treatment of headache disorders. These included a quick reference algorithm, a summary document, patient education sheets, and practice tools (a medication table, a headache history form, a patient diary, and a video demonstrating physical examination of the neck).10. The full guideline provides a detailed medication table for migraine that includes available formulations, usual doses, relative and absolute contraindications, and adverse events. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Based on expert opinion of the Guideline Development Group. Scottish Intercollegiate Guidelines Network, UK: Diagnosis and management of headache in adults, Europe: Treatment of cluster headache and other trigeminal autonomic cephalalgias, Europe: Treatment of tension-type headache, Ibuprofen 400 mg, ASA 1000 mg, naproxen sodium 500550 mg, acetaminophen 1000 mg, Triptans: oral sumatriptan 100 mg, rizatriptan 10 mg, almotriptan 12.5 mg, zolmitriptan 2.5 mg, eletriptan 40 mg, frovatriptan 2.5 mg, naratriptan 2.5 mg, Naproxen sodium 500550 mg in combination with a triptan, Fixed-dose combination analgesics (with codeine if necessary; not recommended for routine use), Consider if patient has depression, anxiety, insomnia, or tension-type headache, Consider as a first-line option if the patient is overweight, Few side effects; limited experience in prophylaxis, Avoid in pregnancy or when pregnancy is possible, For chronic migraine only (headache on 15 d/mo), Consider for migraine in patients with depression, Effectiveness might be limited; few side effects, 12 L/min for 15 min through non-rebreathing mask, 240480 mg/d (higher doses might be required). During a follow-up appointment two months later, she reports that her headaches have improved and now occur only about two to three times per week. 1 Epidural analgesia is commonly used to alleviate labor pain with a reported rate of over 50% at many institutions in the United States and over 85% in tertiary care labor and delivery centers with 24-hour obstetric . https://nccih.nih.gov/health/pain/headachefacts.htm. We thank the members of the Ambassador Program Guideline Development Group, the Advisory Committee, and the Steering Committee for their commitment and hard work. Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. A guideline summary and algorithm, as well as practice tools and patient information sheets, are provided to support comprehensive headache management that emphasizes patient engagement and self-management, as well as evidence-informed interventions. EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. A high dose of vitamin B-2 (riboflavin) also might reduce migraines. Most patients with long-duration chronic daily headaches have migraines or tension-type headaches. An official website of the United States government. Voyez ". There does not appear to be a link between injury severity and PTH severity. Recommendations for diagnosis and management of medication-overuse headache are shown in Boxes 8 and 9.29, Cluster headache is managed with a number of pharmacologic therapies. Before Primary CDH subtypes of long duration (ie, four hours or more) are chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. May A, Leone M, Afra J, Linde M, Sandor PS, Evers S, et al. FOIA European Federation of Neurological Societies, Europe: Pharmacologic treatment of migraine. There was debate among the GDG members about incorporating newly emerging headache treatments that were not identified in the seed guidelines. Several prophylactic treatments for chronic daily headache can reduce headache frequency and severity, as well as improve overall quality of life. In some cases, the GDG requested additional evidence to resolve uncertainties or disagreements regarding interpretation of the evidence from the seed guidelines or when new interventions were considered that had not been included in the seed guidelines. The evidence base for the Alberta CPG will be assessed annually and will be updated when new evidence is found that changes the recommendations. Harstall C, Taenzer P, Angus DK, Moga C, Schuller T, Scott NA. This content does not have an Arabic version. Treatment of chronic migraine (headache occurring on 15 days per month for > 3 months) with onabotulinumtoxinA is recommended in European and Canadian guidelines. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. Guideline for primary care management of headache in adults. Consider other treatment techniques, including transcranial magnetic stimulation and transcutaneous supraorbital nerve stimulation. Treatment Of Chronic Migraine Guidelines. If no such condition is found, treatment focuses on preventing pain. All Rights Reserved. These include cessation of caffeine and tobacco use, improved sleep hygiene, diet changes, and regular mealtimes. It is crucial to avoid frequent and excessive use of analgesics to prevent the development of medication-overuse headache. 107. 670 Canadian Family Physician Le Mdecin de famille canadien | Vol 61:august aot 2015 liical Reie Abstract Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Evidencebased guideline update: pharmacologic treatment for episodic . A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. It is important to evaluate for red flags (Table 23,6 ) that may suggest a secondary cause of headache or a headache requiring more immediate evaluation. Be aware of pre-appointment restrictions. In response to this development, the In the setting of chronic daily headache, concerns about headache from medication overuse should prompt the physician to consider headache prophylaxis to lessen the need for abortive therapy. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Posted on. Chronic daily headache is diagnosed in approximately 3% to 5% of patients presenting with acute headache.1,3 For patients with migraine, modifiable risk factors for progression to chronic migraine include obesity, medication overuse, stressful life events, snoring, caffeine overuse, and other causes of chronic pain.4, In the United States, chronic daily headache is 33% more common in whites and in women.5 The prevalence in women ranges from 5% to 9%, compared with 1% to 3% in men.5,6 In men and women, the prevalence of chronic daily headache is highest in those with lower total education levels.5,6 Overall, among persons who have chronic daily headache, 63% have used medication on 14 days or more of the month in an attempt to treat their headaches.6. This guideline covers advice on the It aims to improve the recognition and management of headaches, with more targeted treatment to improve the quality Headaches: Treatment depends on your diagnosis and symptoms. It is not uncommon for patients who progress to chronic daily headache to have symptoms characteristic of migraine and tension-type headaches, which can present difficulties for targeting a treatment regimen.7. French Society for the Study of Migraine Headache, France: Diagnosis and management of migraine in adults and children. and N.A.S.) Headaches that can occur on a daily or near daily basis include: While tension-type headaches are the most common CDH, they are relatively mild and tolerable. Box 3 presents an approach to the physical examination specifically for primary care providers.29 Copyright 2014 by the American Academy of Family Physicians. A national clinical guideline. Neurologist referral recommended, Diagnose chronic migraine if headaches meet migraine diagnostic criteria (above) or are quickly aborted by migraine-specific medications (triptans or ergots) on 8 d/mo, -Chronic migraine with medication overuse if the patient uses ergots, triptans, opioids, or combination analgesics on 10 d/mo or uses plain acetaminophen or NSAIDs on 15 d/mo, -Chronic migraine without medication overuse if patients do not have medication overuse as defined above, Diagnose chronic tension-type headache if headaches meet episodic tension-type headache diagnostic criteria (above), except mild nausea might be present, -is always on the same side of the head (ptosis or miosis might be present on examination). Several prophylactic treatments for chronic daily headache can reduce headache frequency and severity, as well as improve overall quality of life. 1998-2022 Mayo Foundation for Medical Education and Research (MFMER). Nov 19, 2002. about navigating our updated article layout. Amitriptyline is effective at preventing tension-type headaches after three months of treatment. The most common types of chronic daily headache are chronic migraines and chronic tension-type headaches. We also thank all of the organizations that provided support during the guideline development process, particularly Toward Optimized Practice for guidance in the final stages of the guideline process and for hosting the completed guideline online. AHS will provide this service to assist all health care professionals in their treatment of patients with migraine and related disorders. The guideline will be helpful to a range of primary health care professionals, including family physicians, physical therapists, occupational therapists, nurses, nurse practitioners, pharmacists, psychologists, and chiropractors. This Guidelines summary covers advice on the diagnosis and management of tension-type headache, migraine (including migraine with aura and menstrual-related migraine), cluster headache, and medication overuse headache in young people (aged 12 years and older) and adults. The agency defines chronic headache as having a migraine headache 15 or more days per month with headaches lasting four hours a day or . Table 3 lists some of the more common secondary causes of headache.3 It is important to keep in mind that the most pervasive secondary cause of chronic daily headache, medication overuse, often coexists with a primary headache syndrome. This is a migraine that over time becomes more and more frequent, blurring together until there is a 24-hour-a-day continuous background headache with occasional superimposed, more severe migraine symptoms. After your patient expresses frustration that sumatriptan is no longer working, you explain that overusing the medication can make headaches more frequent. Gabapentin (Neurontin) increases the number of headache-free days in patients with chronic daily headache when compared with placebo. Overview of chronic daily headache. The feedback was incorporated into the final documents, which were approved by the GDG in February 2012. Robbins MS, Lipton RB. For chronic headaches, some questions to ask your doctor include: Your doctor is likely to ask you questions, such as: To ease your headache pain until you see your doctor, you might: Chronic daily headaches care at Mayo Clinic. Silberstein SD, Holland S, Freitag F, et al. The draft guideline was reviewed by the Advisory Committee, a focus group of primary care physicians, and attendees at 2 Alberta physician conferences. will also be available for a limited time. Encourage patients to participate actively in their treatment and to employ self-management principles: -self-monitoring to identify factors influencing migraine, -pacing activity to avoid triggering or exacerbating migraine, -maintaining a lifestyle that does not worsen migraine, -using cognitive restructuring to avoid catastrophic or negative thinking, -improving communication skills to talk effectively about pain with family and others, -using acute and prophylactic medication appropriately, Recurrent migraine attacks are causing considerable disability despite optimal acute drug therapy, Frequency of acute medication use is approaching levels that place the patient at risk of medication-overuse headache, -acute medications are used on 10 d/mo for triptans, ergots, opioids, and combination analgesics, -acute medications are used on 15 d/mo for acetaminophen and NSAIDs, Recurrent attacks with prolonged aura are occurring (hemiplegic migraine, basilar-type migraine, etc), Contraindications to acute migraine medications are making symptomatic treatment of migraine attacks difficult, Educate patients on the need to take the medication daily and according to the prescribed frequency and dosage. Quality of evidenceA comprehensive search was conducted for relevant guidelines and systematic reviews Medication classes used to prevent migraine include antiepileptics, antidepressants, antihypertensives, onabotulinumtoxin-A and CGRP antibodies. Cognitive behavior therapy in group or individualized settings has been shown to reduce headache frequency and severity, and to improve overall quality of life. CMA Infobase: clinical practice guidelines database. Appraisal of Guidelines for Research & Evaluation II. CBTcognitive behavioural therapy, LOClevel of consciousness, NSAIDnonsteroidal anti-inflammatory drug. It may be necessary to hospitalize some patients (e.g., those with intractable migraine, those who are opioid dependent) to discontinue abortive medications in a monitored setting, and to treat the headache with intravenous medications, such as dihydroergotamine.3. Headaches and complementary health approaches. Valproate (Depacon) and topiramate (Topamax) reduce the rate of migraine attacks by at least 50%. Some evidence exists that the herbs feverfew and butterbur help prevent migraines or reduce their severity. Here's some information to help you get ready for your appointment. The medical management of CH may be divided into the treatment of the acute attacks, and 23, 82 Several preventive medications have . These guidelines help promote AHS as the most comprehensive source in the field of headaches for both professionals and patients. All patients should be asked about medication overuse, which can increase the frequency of headaches. Not a specific type of headache, CDH is rather a descriptive term applied to any number of headache types. Frishberg BM, Rosenberg JH, Matchar DB, McCrory DC, Pietrzak MP, Rozen TD, et al. Headache is a common reason why patients seek help from family physicians, and treatment is often suboptimal. Professor in the Department of Clinical Neurosciences at the University of Calgary in Alberta. The recommendations were categorized as do when the evidence supported the intervention, do not do when the evidence suggested the intervention was ineffective or harmful, or do not know when the evidence was equivocal, conflicting, or insufficient. It is estimated that headache accounts for 20% of work absences.6, Vast quantities of over-the-counter medications are taken for headache disorders, and treatment is often suboptimal.1,7 Although most migraine sufferers use acute treatment to relieve their headaches, a substantial number of people who might benefit from prophylactic therapy do not receive itmore than 1 in 4 migraineurs are candidates for preventive therapy.5,8, Better information and education for patients and health professionals is essential to improving management of headache in primary care, which should lead to prompt diagnosis and more effective treatment.9 To help address this, a consortium of organizations and clinicians from Alberta developed the Guideline for Primary Care Management of Headache in Adults.10. Acupuncture also has proven effective for reducing the frequency of headaches in persons with both migraine and tension-type headache, although no significant difference was detected between acupuncture and a sham procedure when looking at persons with migraine alone.11,12, There is a growing body of evidence to suggest that various psychotherapeutic regimens can be effective in decreasing disability for those with chronic daily headache, including Internet-based biofeedback and relaxation techniques that have been shown to decrease headache frequency and severity, and medication use.13 There is somewhat stronger evidence for the use of cognitive behavior therapy for chronic daily headache, both in group and individualized settings.14,15 Cognitive behavior therapy has been shown to reduce headache frequency and severity, and improve overall quality of life.14,15, Emerging evidence suggests that peripheral nerve stimulation in the occipital region can reduce pain, disability, and number of headache days in patients with chronic migraine for at least one year.16, Abortive drug therapies for acute headaches include acetaminophen, nonsteroidal anti-inflammatory drugs, tramadol (Ultram), and triptans.
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