US Headache Consortium Guidelines

The aim of the US Headache Consortium^[1] is to provide scientifically sound, clinically relevant practice guidelines on chronic headache in the primary care setting. The guidelines are intended to improve care and outcomes for all migraine sufferers.

The consortium outlined that the goals of long-term migraine treatment, both pharmacological and non-pharmacological, should be to:

• reduce the frequency, severity, and disability of attacks
• reduce the reliance on poorly tolerated, ineffective or unwanted treatments
• improve quality of life
•  avoid the escalation of acute headache medication
• educate patients and enable them to manage their disease to enhance their control of migraine
• reduce the distress and psychological symptoms related to headache.

The following general management principles were agreed upon:

• establish a diagnosis
• educate migraineurs about their condition and its treatment; discuss the reasons for a particular treatment, how it is used and adverse events that might occur
• establish realistic expectations with the patient, discuss with them the expected benefits of therapy and encourage them to be actively involved in their own management
• base treatment on the frequency and severity of attacks, the degree of disability, and associated symptoms such as nausea and vomiting
• create a management plan that is individualised according to the needs of each patient
• encourage patients to identify and avoid triggers.

In the acute treatment of migraine, the guidelines endorse the use of specific agents, including triptans such as Zomig, in patients with:

• Moderate or severe migraine.
• Mild-to-moderate headache who respond poorly to non-steroidal anti-inflammatory drugs or combinations of simple analgesics.

A non-oral route of administration is recommended in those patients with migraine associated with severe nausea or vomiting.

It is advised that users of this website consult their local treatment guidelines before initiating any treatment programme for a patient with migraine.

Reference:
1. Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000;55: 754-62.