There are international guidelines available for migraine diagnosis but not for treatment (Manack et al., 2009; International Headache Society, 2018). However, there are several local guidelines available to assist in treating migraine patients effectively.
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In the US there are treatment guidelines for treating episodic and chronic migraine and also for prophylaxis (Silberstein, 2000; Silberstein et al., 2012; Marmura et al., 2015; Simpson et al., 2016).
Table 5: Available US treatment guidelines
In Europe, there are European Headache Federation (EHF) guidelines for managing headache (Steiner & Martelletti, 2007) and European Federation of Neurological Sciences (EFNS) guidelines on the drug treatment of migraine (Evers et al., 2009).
EHF guidelines are available in a number of languages.
The EHF also offers advice on migraine management in primary care.
Table 6: Principles of migraine management in primary care, EHF guidelines (Steiner & Martelletti, 2007).
EHF guidelines also offer clear advice on when to use preventive treatment (Steiner & Martelletti, 2007). They recommend initiating preventive therapy, in combination with acute treatment, in adults and children with impaired quality of life, identified by (Steiner & Martelletti, 2007):
EHF guidelines also highlight the risk of over-use of acute therapies, even when the treatment is effective. Migraine prevention drugs are inappropriate for MOH (Steiner & Martelletti, 2007).
There are also US Guidelines for initiating preventive therapy (Silberstein, 2015).