Some advice is also provided for the diagnosis and . There is insufficient evidence to recommend for or against coenzyme Q10, feverfew, melatonin, omega-3, vitamin B2, or vitamin B6 for the prevention of migraine. To earn credits, go to www.cfp.ca and click on the Mainpro link. The goal of First Contact - Headache in Primary Care, powered by the American Headache Society, is to provide educational resources to . government site. There was debate among the GDG members about incorporating newly emerging headache treatments that were not identified in the seed guidelines. The recommendations on management are based on the National Institute for Health and Care Excellence (NICE) guideline Headache in over 12s: diagnosis and management [], the British Association for the Study of Headache (BASH) guideline National headache management system for adults [Ahmed, 2019], the International Headache Society (IHS) publication The International Classification of Headache . A national clinical guideline. The seed guidelines are listed in Table 1.2331 The Alberta guidelines 91 recommendations are organized into 6 sections. The purpose of the BASH Headache Management System for Adults 2019 is to provide a simple, safe and standardised approach which can be used in real time to help . Most headaches presenting in primary care will be primary headaches (without identifiable associated pathology), typically tension headaches or migraines. from publication: The curious case of an atypical headache, a case report and review of literature . There is insufficient evidence to recommend for or against any particular medication for the acute treatment of cluster headache. Via a rigorous analytic process, authors of the practice guideline included randomized controlled trials (RCTs) on the acute pharmacologic treatment of migraine in children younger than 12 years old and adolescents 12-17 years old. It can also be diagnosed when a pre- existing headache disorder significantly worsens in close temporal relation to a causative disorder in which case both the primary and secondary headache diagnoses should be given. 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: Copyright the College of Family Physicians of Canada. Primary headache The major types are listed below - it is important . 2004 Jun;31(2):429-40, viii. The guidelines for management for headache in adults in the primary care setting vary based on the type of headache present in the patient; however, one of the first general practice points for . None of the other authors has any conflict of interest to declare. French guidelines for the diagnosis and management of migraine in adults and children. Adults seeking treatment at hospitals' Emergency Departments (EDs) because of headache represent a major health-care issue. 9, 14 The headache guideline is focused on . Headache is one of the most common reasons patients seek help from family physicians. 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. Management of chronic migraine is complex, and many patients are relatively refractory to therapy. Based on the Scottish Intercollegiate Guidelines Network guideline29 and expert opinion of the Guideline Development Group. Headache is a common reason why patients seek help from family physicians, and treatment is often suboptimal. We suggest ibuprofen, naproxen, aspirin, or acetaminophen for the acute treatment of migraine. Please enable it to take advantage of the complete set of features! The International Classification of Headache Disorders (ICHD) is an algorithmic system to define and classify all known headache disorders. Owing to time and resource constraints, a formal cost analysis or economic evaluation of the effect of the Alberta CPG was not conducted. The 3rd edition was published in 2010 by the committee chaired by Ann McGregor with Paul Davies and Timothy Steiner being the other members. 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 2 to 4.10 Some general practice points are summarized in Box 1. The secondary headaches include: headache attributed to trauma or injury to the head and/or neck, cranial or cervical vascular disorder, non-vascular intracranial disorder, a substance or its withdrawal, infection, disorder of homeostasis, disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, other facial or cervical structure, or psychiatric disorder, Once every other day to eight per day; often occurring at the same time of day, Unilateral orbital, supraorbital, and/or temporal, Causes a sense of agitation or restlessness; routine activity may improve symptoms, May occur, but are often subtle and not noticed by the patient, Prominent autonomic features ipsilateral to the pain (see Appendix A in full text Headache CPG), Sidebar 4: Treatment Options for Tension-type Headachea, b, Physical therapy refers to a range of interventions carried out by licensed physical therapists, including manual therapy, therapeutic exercise, strength and endurance training, self-management training, and adjunctive modalities, Accessible for general practitioners to prescribe, inexpensive, and may help with patients who suffer from insomnia. 3 | Disclaimer, National Library of Medicine Prim Care. It's a quick review for primary . 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. Pulsating quality The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and . It also appears on the Michael G. DeGroote National Pain Centre website35 and is listed by the US National Guideline Clearing House.36 A pilot project is under way at the University of Calgary in Alberta to present the headache guideline using interactive webinars. Clinical Assistant Professor in the Department of Family Medicine at the University of Calgary. We suggest lisinopril for the prevention of episodic migraine. Management of Acute Low Back Pain in Adults Guideline: March 2022: PDF 139KB: Back Pain: Reference: Website: . Sign In to Email Alerts with your Email Address. Naproxen, ibuprofen or aspirin are often sufficient for the treatment of tension-type headache. A guideline summary and algorithm, as well as practice tools and patient . Headache Impact Test (HIT-6) Prim Care. The Guideline Topline in the following slides is an at-a-glance summary of agents and classes of drugs to avoid, stop, or consider carefully listed in the American Heart Association and American College of Cardiology's 2017 Guideline for the Detection, Evaluation, and Management of High Blood Pressure in Adults . Background. Consensus-based decisions made by the subcommittees were then presented to the GDG for final approval. and N.A.S.) We suggest greater occipital nerve block for the acute treatment of migraine. To counter this problem, standardized definitions were constructed for the types of recommendations made in the Alberta CPG (eg, what constituted a do or do not do recommendation) from the overlapping evidence-rating scales used by the seed guidelines, and designations were used (eg, SR for systematic review) to maintain a link to the evidence type referenced by the seed guidelines in support of their recommendations.10,11. To continue viewing this pocket guide, please purchase it. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. First Contact - Headache in Primary Care. Management of Neuropathic Pain for Adults in Primary Care V4.2 Last reviewed: 19/08/2021 Review date: 19/09/2024 Management of Neuropathic Pain for Adults in Primary Care SCOPE This prescribing guideline is to assist primary care prescribers in treating patients with neuropathic pain BEFORE referral to specialist services. We suggest against botulinum/neurotoxin injection for the prevention of chronic tension-type headache. The lead organizations involved in developing the guideline were Toward Optimized Practice (TOP), which develops and disseminates primary care guidelines in Alberta, and the Institute of Health Economics (IHE). An overview of the approach to the patient with a chief complaint of headache is presented here. A special GDG subcommittee, which included a neuroradiologist, was created for the diagnostic imaging recommendations. South East London Pharmacological Management of Adult NonCancer Chronic Pain in Primary care Pain treatment pathway for noncancer chronic pain 3 months duration in adults in primary care1,2,3,4 STEP 2 STEP 1 Assessment and nonpharmacological strategies Assess pain type and severity (appendix B). The common primary headache disorders. There is insufficient evidence to recommend for or against valproate for the prevention of headache. The search identified 64 guidelines, 18 of which were deemed relevant after application of specific selection criteria developed by the research team and content experts from the GDG.11 The quality of the guidelines was appraised independently by 2 reviewers (C.M. Occasionally new recommendations were generated from parking lot item discussions. Most primary headache can be managed in primary care and investigations are rarely needed.12 Transcription . We recommend sumatriptan (oral or subcutaneous), the combination of sumatriptan/naproxen, or zolmitriptan (oral or intranasal) for the acute treatment of migraine. Acute migraine and symptom management. Nutraceuticals: CoQ10, feverfew, melatonin, Evidence suggests small but somewhat inconsistent benefits in reducing migraine frequency, which slightly outweighed potential harms, such as dose variability in supplements, and some specific harms, such as post- feverfew syndrome or vitamin B6 neurotoxicity in high, sustained doses, FDA approved and effective for prevention of chronic migraine, FDA approved and effective for treatment of migraine, Evidence suggests improvement of pain intensity, Ibuprofen, naproxen, aspirin, or acetaminophen, Evidence suggests pain reduction with minimal risks, Sumatriptan, sumatriptan/naproxen, or zolmitriptan, Sumatriptan alone and in combination with naproxen are FDA approved and effective for prevention of migraine, Zolmitriptan is FDA approved and effective for treatment of migraine, Triptans alone and in combination with naproxen are FDA approved and effective for treatment of migraine, Sidebar 7: Treatment Options for Cluster Headache, FDA approved and effective for episodic cluster headache only, For episodic and chronic cluster headache, Evidence is limited for specific pharmacotherapy for acute treatment of cluster headache, FDA approved and effective for episodic and chronic cluster headache, Evidence suggests small or inconsistent benefits for migraine and TTH in comparison to sham acupuncture, No statistically significant differences when compared to beta-blockers, valproic acid, or CCBs, which are also reviewed in this CPG, Aerobic exercise/ progressive strength training, Evidence suggests aerobic exercise and progressive strength training decreases headache frequency, Although CBT and biofeedback are commonly used, there was insufficient evidence in this CPGs systematic evidence review to support a recommendation, While the evidence regarding dietary trigger avoidance is limited, it is reasonable to offer patient education regarding diet modification to decrease the frequency and/or severity of their migraine headache, Evidence of dry needling compared to no treatment was limited, There was insufficient evidence in this CPGs systematic evidence review to support a recommendation, Improved outcomes of headache frequency and other potential benefits outweigh the harms with this relatively low-risk activity, Some patients experienced headache following treatment, Feasibility and acceptability limit these interventions, Further research should be conducted before administering to patients with headache, IV metoclopramide, IV prochlorperazine, or intranasal lidocaine, Dose should be titrated and maintained for at least three months before assessment of response, Dose short-acting four times a day and long-acting two times a day, Dose short-acting 2 3 times a day and long-acting 1 2 times a day, As effective as amitriptyline, propranolol, or valproate, Valproic acid/ divalproex sodium (Depakene, Depakote, Depakote ER), 250 500 mg/ day in divided doses, or daily for extended release, 500 1,500 mg/day in divided doses, or daily for extended release, Calcitonin Gene-related Peptide Inhibitors, May contain polysorbate 80 (also known as Tweens), which can cause hypersensitivity reactions, May cause constipation, packaging may contain latex, 120 mg SQ monthly (migraine), 300 mg SQ (cluster), Can use 240 mg loading dose for migraine, use in cluster should continue monthly until end of cluster period, Use intermittently, such as for menstrual migraine prevention; daily or prolonged use may lead to medication overuse headache and is limited by potential toxicity, Taken in the perimenstrual period to prevent menstrual migraine, May cause transient itching and burning at injection site, May be more helpful in migraine with aura and menstrual migraine, Withdrawal may be associated with increased headaches, Use only commercial preparations, plant is carcinogenic, 1,000 mg at onset; repeat every 4 6 hours as needed, Acetaminophen 250 mg/aspirin 250 mg/caffeine 65 mg (Excedrin Migraine), 50 100 mg at onset; can repeat 50 mg in 8-hours, 550 825 mg at onset; can repeat 220 mg in 3 4 hours, Oral tablet (1 mg) with caffeine 100 mg (Cafergot), 2 mg at onset; then 1 2 mg every 30-minutes as needed. The original wording of the recommendations was retained whenever possible, and designations were used (eg, SR for systematic review, CS for case series) to maintain a link to the evidence cited by the seed guidelines. Anmeldung oder Installation nicht notwendig. Self-medication of migraine and tension-type headache: summary of the evidence-based recommendations of the Deutsche Migrne und Kopfschmerzgesellschaft (DMKG), the Deutsche Gesellschaft fr Neurologie (DGN), the sterreichische Kopfschmerzgesellschaft (KSG) and the Schweizerische Kopfwehgesells Antiepileptics other than gabapentin, pregabalin, topiramate, and valproate for the prophylaxis of episodic migraine in adults, Defining the Pharmacologically Intractable Headache for Clinical Trials and Clinical Practice, Functional serotonin 5-HTTLPR polymorphism is a risk factor for migraine with aura, Adverse reactions related to drugs for headache treatment: clinical impact. We suggest intravenous magnesium for the acute treatment of migraine. Most primary care physicians are extremely experienced in the assessment and management of tension headaches and migraines. The guidelines are updated every three years. The guideline's main focus is primary headache disorders (eg, migraine, tension-type, and cluster headache) and medication-overuse headache. Unless side effects mandate discontinuation, continue the prophylactic drug for at least 68 wk after dose titration is completed, Because migraine attack tendency fluctuates over time, consider gradual discontinuation of the drug for many patients after 6 to 12 mo of successful prophylactic therapy, but preventive medications can be continued for much longer in patients who have experienced substantial migraine-related disability, 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. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache.
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