Consider the following when managing patients with migraine: Prophylactic medication is indicated in the following circumstances: Consider the following when prescribing prophylactic medication: Consider the following in the diagnosis of medication-overuse headache: Treatment plans for patients with medication-overuse headache should include the following. Neuroimaging, sinus or cervical spine x-ray scans, and electroencephalograms are not recommended for the routine assessment of patients with headache: history and physical and neurologic examination findings are usually sufficient to make a diagnosis. Migraine, which is historically underdiagnosed, is by far the most common headache type in patients seeking help for headache. This article follows a single illustrative case of a patient with chronic daily headache. La traduction en franais de cet article se trouve www.cfp.ca dans la table des matires du numro daot 2015 la page e353. Amitriptyline may reduce headache duration and severity compared with placebo for chronic tension-type headache. She has had migraines since she was 14 years of age, but they have become more frequent over the past year. Triptans, muscle relaxants and opioids should not be used. All Rights Reserved. May A, Leone M, Afra J, Linde M, Sandor PS, Evers S, et al.
Headache and migraine clinical practice guidelines: a systematic review EFNS guideline on the treatment of tension-type headache - PubMed Headache is a common reason why patients seek help from family physicians, and treatment is often suboptimal. 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. Those with migraine who have poorly controlled attacks are at risk of medication overuse and more likely to develop medication-overuse headache (Table 5) and chronic migraine, and overuse of medications for the acute treatment of headache may reduce the effectiveness of some preventive treatments. 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. 8600 Rockville Pike Guidelines for acute treatment (Worthington CJNS 2013) Guidelines for prophylaxis (Pringsheim CJNS 2012) Guidelines for acute treatment in the ED (Orr, Cephalalgia 2014) Review on nutraceuticals (Orr, Cephalagia 2015) Review on migraine for primary care (Becker, Can Fam Med 2015) Review on cluster headache (Becker Headache 2013) Publication no. Boxes 6 and 7 show the indications and considerations for prescribing prophylactic drugs for migraine.28,29 Recommended medications are outlined in Table 2.10, Based on Graud et al28 and the Scottish Intercollegiate Guidelines Network guidelines.29, This section contains recommendations on lifestyle, acute and prophylactic drug therapy, and management of tension-type headache during pregnancy. To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. All patients should be asked about medication overuse, which can increase the frequency of headaches. Migraine Headaches Treatment Guidelines That said, 4 a.m. to 9 a.m. is the time when migraines most commonly start. Cet article est disponible en franais. Appraisal of Guidelines for Research & Evaluation II.
Tension Headaches Treatment | UCSF Health NSAIDnonsteroidal anti-inflammatory drug. Occasionally new recommendations were generated from parking lot item discussions. Before Mayo Clinic is a not-for-profit organization. Evidence-based guidelines for migraine headache: behavioral and physical treatments. French Society for the Study of Migraine Headache, France: Diagnosis and management of migraine in adults and children. While there is not a magic bullet for such cases, many patients can be effectively managed with a variety of treatments to substantially reduce pain and disability. 23, 82 Several preventive medications have . Muth C, Gensichen J, Beyer M, Hutchinson A, Gerlach FM. Posted on. HHS Vulnerability Disclosure, Help
Tension headache - Diagnosis and treatment - Mayo Clinic Preventive treatment is aimed at reducing the number of headaches. Not all complementary or alternative therapies have been studied as headache treatments, and others need further research. Ensure that patients have realistic expectations as to what the likely benefits of pharmacologic prophylaxis will be: -Headache attacks will likely not be abolished completely, -A reduction in headache frequency of 50% is usually considered worthwhile and successful, -It might take 48 wk for substantial benefit to occur, -If the prophylactic drug provides substantial benefit in the first 2 mo of therapy, this benefit might increase further over several additional months of therapy, Evaluate the effectiveness of therapy using patient diaries that record headache frequency, drug use, and disability levels, For most prophylactic drugs, initiate therapy with a low dose and increase the dosage gradually to minimize side effects, Increase the dose until the drug proves effective, until doselimiting side effects occur, or until a target dose is reached, Provide an adequate drug trial. She now has a headache almost daily, making it difficult for her to concentrate at work. Migraine prevalence, treatment and impact: the Canadian Women and Migraine Study.
Chronic daily headache treatment guidelines - Australia Examples Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Our caring team of Mayo Clinic experts can help you with your chronic daily headaches-related health concerns, Headaches: Treatment depends on your diagnosis and symptoms, Mayo Clinic expert offers tips to prevent, manage headaches, from migraine to 'rebound', Available Solutions for Headaches from Mayo Clinic Store. Clinical Assistant Professor in the Department of Family Medicine at the University of Calgary. If the cause of your headaches remains uncertain, your doctor might order imaging tests, such as a CT scan or MRI, to look for an underlying medical condition. The principles outlined in the GuideLine Implementability Appraisal tool, which is designed for appraising the implementability of CPGs, were used as a guide when crafting the recommendations.21,22 Standardized definitions for the types of recommendations made in the Alberta CPG were constructed from the evidence-rating scales used by the seed guidelines. Researchers define 'chronic headache' on the basis of frequency (15 days per month) and duration (4 hours per headache day) 3, 6 over the preceding 6 months and it may include either TTH or migraine. The use of one drug is preferred, but if one drug doesn't work well enough, your doctor might consider combining drugs. Types of Migraine
Standards of Care for Headache Diagnosis and Treatment Evidencebased guideline update: pharmacologic treatment for episodic . Providers should give thought to the common side effects, contraindications and . Patients who overuse medications for abortive therapy for headache should be encouraged to stop the medications entirely and consider prophylactic treatment. You're likely to start by seeing your family doctor or a general practitioner. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Diagnose cluster headache or another trigeminal autonomic cephalalgia if headache attacks meet all the following criteria: -ipsilateral conjunctival injection, tearing, or restlessness during the attacks (ipsilateral ptosis or miosis might be present on examination). Chronic daily headaches, which occur 15 days or more a month, are one sub-type. Pharmacologic therapies include amitriptyline, gabapentin, onabotulinumtoxinA, propranolol, tizanidine, topiramate, and valproate. 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). Research Associate in Health Technology Assessment at the Institute of Health Economics in Edmonton, Alta. Based on expert opinion of the Guideline Development Group. American Headache Society. To help offset this, the research team updated searches regularly throughout the Alberta guideline adaptation process. Table 5 presents a simplified strategy for diagnosing primary headache disorders.32,33. The full guideline provides a detailed medication table for migraine that includes available formulations, usual doses, relative and absolute contraindications, and adverse events. A series of companion documents were created, adapted, or adopted to support the implementation of the guideline. Barriers to satisfactory migraine outcomes. PMC legacy view All rights reserved. Quick reference algorithm from the Guideline for Primary Care Management of Headache in Adults. Applying heat or ice whichever you prefer to sore muscles may ease a tension-type headache. Take a family member or friend along, if possible, to help you remember information. Section 2 of the guideline contains recommendations for lifestyle management, acute treatment, prophylaxis, menstrual migraine, and migraine treatment during pregnancy. The Advisory Committee advised the Steering Committee on strategic matters and included representatives from the Alberta College of Family Physicians, the Alberta College of Physicians and Surgeons, Alberta Health Services, Alberta Health, the Pain Society of Alberta, and a chronic pain patient advocacy group, as well as experts in guideline development and dissemination. Doctors use many types of drugs to treat or prevent. Genital herpes is a chronic, lifelong viral infection. A research team of health technology assessment researchers with methodologic expertise from the IHE assisted the Steering Committee and GDG.11, The Alberta guideline was developed using a guideline adaptation process, which takes advantage of existing high-quality guidelines and allows guideline developers to modify the recommendations from these seed guidelines to meet the needs of the local health care setting.12 Guideline adaptation is a popular alternative to de novo guideline development owing to the need to reduce duplication and constrain costs in the creation of evidence-informed guidelines.1315. The full guideline and accompanying documents are available from the TOP website.10 The quick reference algorithm* information is provided in Figure 1 and Tables 22 to to44.10 Some general practice points are summarized in Box 1. She was prompted to make this appointment after receiving a negative performance appraisal from her supervisor. This guideline, for use by primary care providers, explains the evaluation, treatment, and referral process for children and adolescents (ages 3-21 years) whose chief complaint is headache. They include aspirin, acetaminophen, ibuprofen and naproxen. Before trying complementary or alternative therapy, discuss the risks and benefits with your doctor. Cooke LJ, Becker WJ. Because out of control migraines can transform into a CDH that is difficult to treat, it is very important to establish a good preventive regimen as early in life as possible. There was debate among the GDG members about incorporating newly emerging headache treatments that were not identified in the seed guidelines. A patient who has headaches as many days as not at least 15 days per month is said to have chronic daily headache (CDH).
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