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Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review) [RETIRED]: Report of the Quality Standards Subcommittee of the American Academy of Neurology

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Silberstein, Stephen D.·2000·Neurology
DOI 10.1212/wnl.55.6.754
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Abstract

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][2][3][4][5][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?Description of the process.Seven organizations participated in The US Headache Consortium: the American Academy of Family Physicians, AAN, American Headache Society (formerly the American Association for the Study of * Members of the US Headache Consortium are listed in Appendix 1. From the American Academy of Neurology, St. Paul, MN.

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Authors
Silberstein, S. D.
Venue
Neurology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2000-09-26
Volume
55
Issue
6
Pages
754-762
ISSN
  • 0028-3878 (ISSN-L)
  • 1526-632X
DOI
10.1212/wnl.55.6.754
OpenAlex
W2166530830
Cited by
1,360
References
0
FWCI
25.62
Type
journal article
Language
en
Open access
bronze

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