The 2012 AHS/AAN Guidelines for Prevention of Episodic Migraine: A Summary and Comparison With Other Recent Clinical Practice Guidelines

ArticleinHeadache The Journal of Head and Face Pain 52(6):930-45 · June 2012with52 Reads
DOI: 10.1111/j.1526-4610.2012.02185.x · Source: PubMed
Updated guidelines for the preventive treatment of episodic migraine have been issued by the American Headache Society (AHS) and the American Academy of Neurology (AAN). We summarize key 2012 guideline recommendations and changes from previous guidelines. We review the characteristics, methods, consistency, and quality of the AHS/AAN guidelines in comparison with recently issued guidelines from other specialty societies. To accomplish this, we reviewed the AHS/AAN guidelines and identified comparable recent guidelines through a systematic MEDLINE search. We extracted key data, and summarized and compared the key recommendations and assessed quality using the Appraisal of Guidelines Research and Evaluation-II (AGREE-II) tool. We identified 2 additional recent guidelines for migraine prevention from the Canadian Headache Society and the European Federation of Neurological Societies. All of the guidelines used structured methods to locate evidence and linked recommendations with assessment of the evidence, but they varied in the methods used to derive recommendations from that evidence. Overall, the 3 guidelines were consistent in their recommendations of treatments for first-line use. All rated topiramate, divalproex/sodium valproate, propranolol, and metoprolol as having the highest level of evidence. In contrast, recommendations diverged substantially for gabapentin and feverfew. The overall quality of the guidelines ranged from 2 to 6 out of 7 on the AGREE-II tool. The AHS/AAN and Canadian guidelines are recommended for use on the basis of the AGREE-II quality assessment. Recommendations for the future development of clinical practice guidelines in migraine are provided. In particular, efforts should be made to ensure that guidelines are regularly updated and that guideline developers strive to locate and incorporate unpublished clinical trial evidence.
    • "metoprolol and propranolol) are the most common preventive drug treatment options, but other alternatives, such as tricyclic antidepressants , are also used [4]. According to guidelines, patients who experience migraine attacks requiring treatment more often than twice a month should be offered preventive drug treat- ment [6] ( A n v a n d -a n f a l l s f o r e b y g g a n d e -b e h a n d l i n g -h o s - migranpatienter-med-tva-eller-fler-behandlingskravandeanfall-per-manad/ (accessed Jan. 15, 2016)). "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: Triptans are widely used in acute migraine, and in some countries, they are also available over-the-counter (OTC). In Sweden, sales have increased for both prescription and OTC triptans. This study aimed to describe current prescribing and utilisation patterns of prescription and OTC triptans in Stockholm, Sweden. Methods: Register data from 4759 patients dispensed triptans in 2014 were used to study documented diagnosis of migraine, concomitant acute and preventive treatment for migraine, and contraindications. Survey data from 49 patients purchasing OTC triptans in three pharmacies were used to capture physician-diagnosed migraine, concomitant acute and preventive treatment for migraine, a behaviour of combining or alternating between prescription and OTC triptans, and pharmacy counselling rates. Results: Among the prescription triptan users, 52 % had a recorded diagnosis of migraine, 48 % had no other acute treatment, preventive treatment was rare (12 %) and contraindications were found in 2 % of the patients. Among the OTC triptan users, the majority (63 %) had been diagnosed by a physician and had a history of prescription triptan use, but combining or alternating between OTC and prescription triptans was rare. Concomitant acute treatment was reported in 53 % and preventive treatment was rare (4 %), despite high self-reported migraine frequencies. Some off-label use was detected, despite moderate to high counselling rates. Conclusion: Triptans are prescribed with attention to safety but with poor recording of migraine diagnosis. OTC triptan users generally have a history of prescription triptan use. Preventive treatment rates are low in both groups. Strategies to discern patients who need other treatment options should be considered.
    Full-text · Article · Feb 2016
    • "As such, the results of this study have a limitation regarding secondary RLS. Third, some medications such as neuroleptic agents, antidepressants , opioid antagonists, and antiemetic agents can cause or exacerbate RLS and cease or relieve migraine [45, 46]. Elderly populations are more likely to take these medications and that could result in a higher RLS prevalence within the elderly group without altering the migraine prevalence. "
    [Show abstract] [Hide abstract] ABSTRACT: Recent studies have shown an association between migraine and restless legs syndrome (RLS). However, migraine prevalence peaks from the 20s to 40s whereas RLS prevalence peaks after the 50s. Despite this, reports on how migraine and RLS may be associated by age is limited. Therefore, the purpose of this study is to investigate the comorbidity between migraine and RLS according to age. We selected a stratified random population sample of Koreans aged 19 to 69 years and evaluated them with a 60-item semi-structured interview designed to identify RLS, headache type, and clinical characteristics of migraine. To assess the association between migraine and RLS according to age, we divided participants into 5 age groups (19-29, 30-39, 40-49, 50-59, and 60-69 years) and analysed each group. Subjects with migraine showed an increased RLS prevalence in the 19-29 (Odds ratio [OR] = 6.6, 95 % confidence interval [CI] = 1.2-36.8) and 40-49 (OR = 6.7, 95 % CI = 1.5-33.5) age groups compared to non-headache controls but failed to showed a significant association in the 50-59 (OR = 1.1, 95 % CI = 0.2-5.6) and 60-69 (OR = 0.4, 95 % CI = 0.1-4.0) age groups. Migraineurs with 1-10 (12.5 %, OR = 2.0, 95 % CI = 1.3-3.2, p = 0.003) and >10 (12.5 %, OR = 2.5, 95 % CI = 1.0-5.6, p = 0.038) attacks per month showed an increased RLS prevalence compared to migraineurs with <1 attack per month (2.1 %). Subjects with non-migraine headaches showed an increased odds for RLS (OR = 1.8, 95 % CI = 1.3-2.7) compared to non-headache controls. There was no significant difference (9.1 % vs. 6.9 %, p = 0.339) in the RLS prevalence between migraineurs and non-migraine headache subjects. Our results suggest that migraine and RLS are differently associated according to age.
    Full-text · Article · Dec 2015
    • "Preventive pharmacotherapy is used in conjunction with effective nonpharmacologic approaches as part of a comprehensive plan including avoidance of migraine triggers, implementation of lifestyle changes, stress management techniques, and a reduction in the use of analgesics or acute migraine medications [181]. Preventive treatment is aimed at patients who [ Source: [205]Table 2 Preventive medications improve patients' quality of life and health outcomes and reduce disability and healthcare costs [184; 185]. The decision to opt for preventive pharmacotherapy should be discussed with the patient and should take into consideration the variability in patient response and the possibility of significant side effects [185]. "
    [Show abstract] [Hide abstract] ABSTRACT: This publication provides an integrated update of the recent developments on the pathophysiology of migraine and resulting “mechanism-related” therapies, to evaluate the clinical benefit-risk ratio of antimigraine medications, and to summarize the current and evidence-based guidelines for the clinical management of migraine. The information provided contributes to a more positive interaction between patients and healthcare professionals, through fostering patient awareness, implementation of lifestyle changes, and compliance to therapy.
    Full-text · Article · Jul 2015 · The Journal of Headache and Pain
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