Treatment Guidelines for Acute Migraine Attacks Treatment Guideline Subcommittee of the Taiwan Headache Society (original) (raw)
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Neurology, 2000
for the US Headache Consortium * Mission statement. The Quality Standards Subcommittee (QSS) of the American Academy of Neurology (AAN) is charged with developing practice parameters for physicians. This practice parameter summarizes the results from the four evidence-based reviews on the management of patients with migraine: specifically, acute, preventive, and nonpharmacologic treatments for migraine, and the role of neuroimaging in patients with headache. The full papers for these treatment guidelines are published elsewhere, 1-6 and only the specific treatment recommendations are summarized below. Background and justification. Migraine is a very common disorder. An estimated 18% of women and 6% of men experience migraine, but many go undiagnosed and undertreated. 7 There have been a number of advances in the diagnosis and treatment of migraine as well as great strides in understanding its pathogenesis, making it one of the best understood of the neurologic disorders. Migraine is characterized by enhanced sensitivity of the nervous system. The attack is associated with activation of the trigeminal-vascular system. In June 1998, Duke University's Center for Clinical Health Policy Research, in collaboration with the AAN, completed four Technical Reviews on migraine sponsored by the Agency for Health Care Policy and Research. These reviews covered self-administered drug treatments for acute migraine 8 ; parenteral drug treatments for acute migraine 9 ; drug treatments for the prevention of migraine 10 ; and behavioral and physical treatments for migraine. 11 The Education and Research Foundation of the AAN later funded additional reports on diagnostic testing for headache patients, an update on sumatriptan and other 5-HT 1 agonists, and a report on butalbital-containing compounds for migraine and tension-type headache, using the same methodology that was used in the original Technical Reviews. A multidisciplinary panel of professional organizations (The US Headache Consortium) produced four treatment guidelines, each related to a distinct set of management decisions: diagnostic testing (primarily neuroimaging studies), pharmacologic management of acute attacks, migraine-preventive drugs, and behavioral and physical treatments for migraine.
The Journal of Headache and Pain
Background The objective of this review was to determine the unmet needs for migraine in East Asian adults and children. Methods We searched MEDLINE and EMBASE (January 1, 1988 to January 14, 2019). Studies reporting the prevalence, humanistic and economic burden, and clinical management of migraine in China (including Hong Kong and Taiwan), Japan, and South Korea were included. Studies conducted before 1988 (before the International Headache Society [IHS] first edition of the International Classification of Headache Disorders) were not included. Results We retrieved 1337 publications and 41 met the inclusion criteria (28 from China, 7 from Japan, and 6 from South Korea). The 1-year prevalence of migraine (IHS criteria) among adults ranged from 6.0% to 14.3%. Peak prevalence ranged from 11% to 20% for women and 3% to 8% for men (30- to 49-year-olds). For children, prevalence of migraine increased with age. Information on the economic burden and clinical management of migraine was li...
Pharmacological treatments for acute migraine: quantitative systematic review
Pain, 2002
To compare the analgesic efficacy and adverse effects of different pharmacological treatments for acute migraine. Searching Pfizer provided the data on all relevant randomised controlled trials (RCTs) for eletriptan. For all other drugs, the following databases were searched for studies reported in any language: MEDLINE (from 1966 to July 2000), EMBASE (from 1980 to June 200), the Cochrane Library (Issue 3, 2000) and the Oxford Pain Relief Database (from 1950 to 1994). The search strategy included a series of free text terms for generic and trade names of each medication indicated for migraine and any widely available analgesics. The search was restricted to published reports. Study selection Study designs of evaluations included in the review Only double-blind randomised placebo-controlled trials were considered for inclusion. Specific interventions included in the review Any pharmacological treatment for acute migraine was considered for inclusion, but only studies that examined the use of single-dose treatment at a standard dose were included. The drugs evaluated by the included studies were rizatriptan (5 and 10 mg), naratriptan (2.5 mg), sumatriptan (6, 20, 50 and 100 mg), aspirin (900 mg) plus metoclopramide (10 mg), zolmitriptan (2.5 and 5 mg), dihydroergotamine mesilate (2 mg), Excedrin (paracetamol 500 mg plus aspirin 500 mg plus caffeine 130 mg), tolfenamic acid rapid release (200 to 400 mg), eletriptan (40 and 80 mg), Cafergot (ergotamine tartrate 2 mg plus caffeine 200 mg) and placebo. Sumatriptan (6 mg) was administered subcutaneously, sumatriptan (20 mg) and dihydroergotamine mesilate (2 mg) were intranasal drugs, and the remainder were oral drugs. Participants included in the review Adult patients suffering from a single migraine attack of moderate or severe intensity were eligible for inclusion. Only studies that used the International Headache Society's diagnostic criteria for migraine with or without aura (see Other Publications of Related Interest) were included. Outcomes assessed in the review Only studies reporting dichotomous or percentage data for at least one of the following outcomes were eligible for inclusion: headache relief (headache pain reduced from moderate or severe to mild or none) at 2 hours; headache relief at 1 hour; pain-free response (headache pain reduced from moderate or severe to none) at 2 hours; sustained relief over 24 hours (headache relief at 2 hours sustained for 24 hours after treatment, i.e. pain did not return to moderate or severe, and without use of rescue or second-dose medication); and pain-free over 24 hours (pain-free at 2 hours, sustained for 24 hours after treatment, i.e. pain did not return to moderate or severe, and without use of rescue or second-dose medication). The review also considered the evaluation of adverse effects that occurred within 24 hours of treatment in terms of the following: the incidence of major harm resulting in withdrawal from the study; any undesirable side-effects considered to be related to the study drug; and the incidence of particular adverse effects. How were decisions on the relevance of primary studies made? The authors do not state how the papers were selected for the review, or how many of the reviewers performed the selection. Assessment of study quality The studies were scored for quality according to the Jadad criteria. Two reviewers independently assessed each study. It
Neurology, 2000
for the US Headache Consortium * Mission statement. The Quality Standards Subcommittee (QSS) of the American Academy of Neurology (AAN) is charged with developing practice parameters for physicians. This practice parameter summarizes the results from the four evidence-based reviews on the management of patients with migraine: specifically, acute, preventive, and nonpharmacologic treatments for migraine, and the role of neuroimaging in patients with headache. The full papers for these treatment guidelines are published elsewhere, 1-6 and only the specific treatment recommendations are summarized below. Background and justification. Migraine is a very common disorder. An estimated 18% of women and 6% of men experience migraine, but many go undiagnosed and undertreated. 7 There have been a number of advances in the diagnosis and treatment of migraine as well as great strides in understanding its pathogenesis, making it one of the best understood of the neurologic disorders. Migraine is characterized by enhanced sensitivity of the nervous system. The attack is associated with activation of the trigeminal-vascular system. In June 1998, Duke University's Center for Clinical Health Policy Research, in collaboration with the AAN, completed four Technical Reviews on migraine sponsored by the Agency for Health Care Policy and Research. These reviews covered self-administered drug treatments for acute migraine 8 ; parenteral drug treatments for acute migraine 9 ; drug treatments for the prevention of migraine 10 ; and behavioral and physical treatments for migraine. 11 The Education and Research Foundation of the AAN later funded additional reports on diagnostic testing for headache patients, an update on sumatriptan and other 5-HT 1 agonists, and a report on butalbital-containing compounds for migraine and tension-type headache, using the same methodology that was used in the original Technical Reviews. A multidisciplinary panel of professional organizations (The US Headache Consortium) produced four treatment guidelines, each related to a distinct set of management decisions: diagnostic testing (primarily neuroimaging studies), pharmacologic management of acute attacks, migraine-preventive drugs, and behavioral and physical treatments for migraine. Clinical question statements. Specific clinical questions addressed in these practice parameters included the following: Acute and preventive treatment-What are the effects on acute headache pain of medications taken during the attack? What are the effects on the frequency and/or severity of migraine attacks of medications taken on a daily basis for prevention of migraine? How safe and tolerable are acute and preventive migraine medications? How do the efficacy and tolerability issues of medications for migraine compare to placebo, alternative medications, and nonpharmacologic techniques? Diagnostic testing-What is the role of neuroimaging in patients who present with headache? Are particular findings in the history and on the physical examination helpful in identifying which patients have significant intracranial abnormalities? What is the frequency of significant secondary causes of nonacute headache, as detected by CT or MRI, in patients who present with nonacute headache and a normal neurologic examination? What evidence exists concerning the relative ability of CT and MRI to detect significant intracranial lesions among patients with nonacute headache?
The practice pattern of migraine management among neurologists in Taiwan
Cephalalgia, 2006
To assess the prevalence of migraine and the attitudes and practice patterns of Taiwanese neurologists regarding migraine management, we mailed the survey questionnaire to all of the actively practicing board-certified neurologists from the membership list of the Taiwan Neurological Association. Of the targeted 531 neurologists, 123 (23.2%) participated in this study. Thirty of the participants (27.6%) reported having migraine. Most neurologists (88.5%) felt that headache was an important part of their practice. Many neurologists (65.0%) used neuroimaging to evaluate patients with severe headache and 44.7% used electroencephalography for headache evaluation. Many participants knew that combination analgesic was a common cause of medication-overuse headache, but did not know that ergotamine, acetaminophen and triptans were possible aetiologies of medication-overuse headache. Our study suggests that awareness of medicationoveruse headache and the indications of neuroimaging should be stressed in Taiwan, and headache guidelines should be modified according to local factors.
Headache, 2015
The study aims to provide an updated assessment of the evidence for individual pharmacological therapies for acute migraine treatment. Pharmacological therapy is frequently required for acutely treating migraine attacks. The American Academy of Neurology Guidelines published in 2000 summarized the available evidence relating to the efficacy of acute migraine medications. This review, conducted by the members of the Guidelines Section of the American Headache Society, is an updated assessment of evidence for the migraine acute medications. A standardized literature search was performed to identify articles related to acute migraine treatment that were published between 1998 and 2013. The American Academy of Neurology Guidelines Development procedures were followed. Two authors reviewed each abstract resulting from the search and determined whether the full manuscript qualified for review. Two reviewers studied each qualifying full manuscript for its level of evidence. Level A evidenc...
Cephalalgia : an international journal of headache, 2018
Background Quality clinical trials form an essential part of the evidence base for the treatment of headache disorders. In 1991, the International Headache Society Clinical Trials Standing Committee developed and published the first edition of the Guidelines for Controlled Trials of Drugs in Migraine. In 2008, the Committee published the first specific guidelines on chronic migraine. Subsequent advances in drug, device, and biologicals development, as well as novel trial designs, have created a need for a revision of the chronic migraine guidelines. Objective The present update is intended to optimize the design of controlled trials of preventive treatment of chronic migraine in adults, and its recommendations do not apply to trials in children or adolescents.
Current Recommendation for the Treatment of Acute Migraine
International Journal of Research, 2016
Migraine is the second most common reason behind patient complaining with headache. It is a common, disabling headache disorder, with substantial social and economic bearing, and is currently ranked by the World Health Organization as 19th among causes of years, which are lived with disability. The treatment of migraine is specific for each and every patient. The present review article focuses on the current recommendations for the treatment of acute migraine. Key Words: Migraine, treatment, drugs, therapy.