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MIGRAINE HEADACHE
Treatment Guideline Chart
Migraine headache without aura has at least 5 attacks of any 2 symptoms of unilateral headache that is throbbing or pulsating in nature, moderate to severe in pain and activity aggravates pain. It is accompanied with either nausea and vomiting or photophobia and/or phonophobia. The symptoms last for 4-72 hours without signs of secondary headache.
Migraine headache with aura has at least 2 attacks with any of the fully reversible symptoms of flickering lights, spots or lines and/or vision loss, sensory symptoms of pins and needles and/or numbness and dysphasic speech disturbance but without motor weakness. Accompanied by at least 2 of the following symptoms of homonymous visual symptoms and/or unilateral sensory symptoms or at least 1 aura symptom develops gradually over ≥5 minutes and/or different aura symptoms that occur in succession over ≥5 minutes.

Migraine Headache References

  1. Aukerman G, Knutson D, Miser WF. Management of the acute migraine headache. Am Fam Physician. 2002 Dec;66(11):2123-2130. http://www.aafp.org. PMID: 12484694
  2. Dowson AJ, Lipscombe S, Sender J, et al. New guidelines for the management of migraine in primary care. Curr Med Res Opin. 2002;18(7):414-439. PMID: 12487508
  3. Dodick DW. Acute and prophylactic management of migraine. Clin Cornerstone. 2001;4(3):36-52. PMID: 12739315
  4. Evers S, Afra J, Frese A, et al. EFNS guideline on the drug treatment of migraine - revised report of an EFNS task force. Eur J Neurol. 2009 Sep;16(9):968-981. doi: 10.1111/j.1468-1331.2009.02748.x. PMID: 19708964
  5. Goadsby PJ, Lipton RB, Ferrari MD. Migraine-current understanding and treatment. N Engl J Med. 2002 Jan;346(4):257-270. doi: 10.1056/NEJMra010917. PMID: 11807151
  6. Ferrari MD. Migraine. Lancet. 1998 Apr;351(9108):1043-1051. PMID: 9546526
  7. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(Suppl 1):9-160. PMID: 14979299
  8. Schroeder BM. AAFP/ACP-ASIM release guidelines on the management and prevention of migraines. Am Fam Physician. 2003 Mar;67(6):1392-1397. http://www.aafp.org. PMID: 12674472
  9. Morey SS. Guidelines on migraine: part 5. Recommendations for specific prophylactic drugs. Am Fam Physician. 2000 Dec;62(11):2535-2539. http://www.aafp.org. PMID: 11130237
  10. Nattero G, Agostoni A, Brandi G, et al. Therapeutic possibilities in idiopathic headaches. Analysis of about 1000 cases [abstract, in Italian]. Minerva Med. 1976 Jun;67(31):1999-2006. PMID: 934545
  11. Martin V, Elkind A. Diagnosis and classification of primary headache disorders. Standards of Care for headache diagnosis and treatment. Chicago (IL): National Headache Foundation. 2004:004-18.
  12. Siniachkin MS, Veĭn AM, Voznesenskaia TG, et al. Sulpiride in the prophylactic treatment of migraine [abstract in Russian]. Zh Nevrol Psikhiatr Im S S Korsakova. 1997;97(11):28-32. PMID: 9463033
  13. Silberstein SD, Holland S, Freitag F, et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012 Apr;78(17):1337-1345. doi: 10.1212/WNL.0b013e3182535d20. PMID: 22529202
  14. Silberstien 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 Sep;55(6):754-762. doi: 10.1212/wnl.55.6.754. PMID: 10993991
  15. Snow V, Weiss K, Wall EM, Mottur-Pilson C; American Academy of Family Physicians; American College of Physicians-American Society of Internal Medicine. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med. 2002 Nov;137(10):840-849. doi: 10.7326/0003-4819-137-10-200211190-00014. PMID: 12435222
  16. MedWormhttp://www.medworm.com/rss/index.php/Neurology/25/http://www.medworm.com/rss/medicalfeeds/specialities/Neurology.xml
  17. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  18. Scottish Intercollegiate Guidelines Network. Diagnosis and management of headache in adults. SIGN. http://www.sign.ac.uk. Nov 2008. Accessed 10 Feb 2011.
  19. Ministry of Health Singapore. Clinical practice guidelines: diagnosis and management of headache. MOH (Singapore). http://www.moh.gov.sg. 2007
  20. Ramadan NM, Silberstein SD, Freitag FG, et al. Evidence-based guidelines for migraine headache in the primary care setting: pharmacological management for prevention of migraine. American Academy of Neurology. https://www.aan.com. Apr 2000.
  21. Campbell JK, Penzien DB, Wall EM. Evidence-based guidelines for migraine headache: behavioral and physical treatments. American Academy of Neurology. https://www.aan.com. 25 Apr 2000.
  22. Matchar DB, Young WB, Rosenberg JH, et al. Evidence-based guidelines for migraine headache in the primary care setting: Pharmacological management of acute attacks. American Academy of Neurology. https://www.aan.com. 2000.
  23. MacGregor EA, Steiner TJ, Davies PTG for the British Association for the Study of Headache. Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type, cluster and medication-overuse headache. 3rd ed (1st rev). British Association for the Study of Headache. http://www.bash.org.uk. Sep 2010.
  24. MIPCA: Migraine in Primary Care Advisors. MIPCA guidelines for the management of migraine in primary care. 2nd ed. http://www.mipca.org.uk. Jan 2004.
  25. Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the American Headache Society evidence assessment of migraine pharmacotherapies. Headache. 2015;55(1):3-20. doi: 10.1111/head.12499. Accessed 18 Feb 2015. PMID: 25600718
  26. Beithon J, Gallenberg M, Johnson K, et al. Diagnosis and treatment of headache. Institute for Clinical Systems Improvement (ICSI). https://www.icsi.org. Jan 2013. Accessed 16 Apr 2015.
  27. National Institute for Health and Care Excellence (NICE). Headaches: diagnosis and management of headaches in young people and adults. NICE clinical guideline 150. National Institute for Health and Care Excellence. https://www.nice.org.uk. Sep 2012. Accessed 24 Apr 2015.
  28. Pringsheim T, Davenport W, Mackie G, et al. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012 Mar;39(2)(Suppl 2):S1-S59. http://headachenetwork.ca. Accessed 14 Apr 2016. PMID: 22683887
  29. Bajwa ZH, Smith JH. Acute treatment of migraine in adults. UpToDate. https://www.uptodate.com. Mar 2019. Accessed 04 Jun 2019.
  30. Becker WJ. Acute migraine treatment in adults. Headache. 2015 Jun;55(6):778-793. doi: 10.1111/head.12550. Accessed 2 May 2017. PMID: 25877672
  31. Cutrer FM. Pathophysiology, clinical manifestations, and diagnosis of migraine in adults. UpToDate. https://www.uptodate.com. Nov 2018. Accessed 2 May 2017.
  32. Garza I, Schwedt TJ. Chronic migraine. UpToDate. https://www.uptodate.com. Dec 2018. Accessed 28 Feb 2019.
  33. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. doi: 10.1177/0333102413485658. Accessed 2 May 2017. PMID: 23771276
  34. Peng KP, Wang SJ. Epidemiology of headache disorders in the Asia-Pacific region. Headache. 2014 Apr;54(4):610-618. doi: 10.1111/head.12328. Accessed 24 Mar 2017. PMID: 24666014
  35. Robertson CE, Black DF, Swanson JW. Management of migraine headache in the emergency department. Semin Neurol. 2010 Apr;30(2):201-211. doi: 10.1055/s-0030-1249228. Accessed 2 May 2017. PMID: 20352590
  36. Rozen TD. Emergency department and inpatient management of status migrainosus and intractable headache. Continuum (Minneap Minn). 2015 Aug;21(4):1004-1017. doi: 10.1212/CON.0000000000000191. Accessed 2 May 2017. PMID: 26252587
  37. World Health Organization. Headache disorders. WHO. https://www.who.int. Apr 2016. Accessed 24 Mar 2017.
  38. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi: 10.1177/0333102417738202. Accessed 20 Feb 2018. PMID: 29368949
  39. Becker WJ, Findlay T, Moga C, et al. Guideline for primary care management of headache in adults. Can Fam Physician. 2015 Aug;61(8):670-679. Accessed 20 Feb 2019. PMID: 26273080
  40. Institute of Health Economics Alberta Canada. Primary care management of headache in adults clinical practice guideline. http://www.topalbertadoctors.org. Sep 2016. Accessed 20 Feb 2019.
  41. American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache. 2019 Jan;59(1):1-18. doi: 10.1111/head.13456. PMID: 30536394
  42. Bajwa ZH, Smith JH. Preventive treatment of migraine in adults. UpToDate. https://www.uptodate.com. Dec 2018. Accessed 28 Feb 2019.
  43. Diener HC, Holle-Lee D, Nägel S, et al. Treatment of migraine attacks and prevention of migraine: guidelines by the German Migraine and Headache Society and the German Society of Neurology. Clinical and Translational Neuroscience. 2019:1-40. doi: 10.1177/2514183X18823377.
  44. MacGregor A. Management of migraine during pregnancy. Progress in Neurology and Psychiatry banner. 2009 Oct;13(5):21-24. doi: 10.1002/pnp.137.
  45. National Institute for Health and Clinical Excellence. Botulinum toxin type A to prevent chronic migraine headaches. NICE. http://www.nice.org.uk. Jun 2012. Accessed 04 Jun 2019.
  46. Robbins MS. Migraine in pregnancy. American Headache Society. http://www.americanheadachesociety.org. Accessed 04 Jun 2019.
  47. Gilmore B, Michael M. Treatment of acute migraine headache. Am Fam Physician. 2011 Feb;83(3):271-280. PMID: 21302868
  48. Hainer B, Matheson E. Approach to acute headaches in adults. Am Fam Physician. 2013 May;87(10):682-687. http://www.aafp.org. Accessed 23 Apr 2015. PMID: 23939446
  49. Lipton RB, Diener H, Robbins MS, et al. Caffeine in the management of patients with headache. J Headache Pain. 2017;18(1):107. doi: 10.1186/s10194-017-0806-2. Accessed 3 Sep 2019. PMID: 29067618
  50. Smith JH. Acute treatment of migraine in adults. UpToDate. https://www.uptodate.com. 01 Aug 2019. Accessed 6 Sep 2019.
  51. Smith JH. Preventive treatment of migraine in adults. UpToDate. https://www.uptodate.com. 28 Aug 2019. Accessed 6 Sep 2019.
  52. FDA approves new treatment for patients with migraine. U.S. Food and Drug Administration. https://www.fda.gov. 11 Oct 2019. Accessed 07 Nov 2019.
  53. Calhoun AH. Estrogen-associated migraine. UpToDate. https://www.uptodate.com. 17 Dec 2018.
  54. Carmona S, Bruera O. Prophylactic treatment of migraine and migraine clinical variants with topiramate: an update. Ther Clin Risk Manag. 2009;5:661-669. PMID: 19707282
  55. Chawla J. Migraine headache. Medscape. https://emedicine.medscape.com. 21 Oct 2019.
  56. Deleu D, Hanssens Y. Guidelines for the prevention of migraine. Neurosciences (Riyadh). 2000 Jan;5(1):7-12. PMID: 24276654
  57. Estemalik E, Tepper S. Preventive treatment in migraine and the new US guidelines. Neuropsychiatr Dis Treat. 2013;9:709-720. doi: 10.2147/NDT.S33769. PMID: 23717045
  58. Lipchik GL. Biofeedback and relaxation training for headaches. American Migraine Foundation. https://americanmigrainefoundation.org. 12 Nov 2016.
  59. Loder E, Burch R and Rizzoli P. The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines. Headache. 2012 Jun;52(6):930-945. doi: 10.1111/j.1526-4610.2012.02185.x. PMID: 22671714
  60. Mikkelsen B, Pedersen KK, Christiansen LV. Prophylactic treatment of migraine with tolfenamic acid, propranolol and placebo. Acta Neurol Scand. 1986 Apr;73(4):423-427. doi: 10.1111/j.1600-0404.1986.tb03299.x. PMID: 3727918
  61. National Institute for Health and Care Excellence (NICE). Management of migraine (with or without aura). NICE. https://www.nice.org.uk/.
  62. Orr SL, Aube M, Becker WJ, et al. Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings. Cephalalgia. 2015 Mar;35(3):271-284. doi: 10.1177/0333102414535997. PMID: 24875925
  63. Scottish Intercollegiate Guidelines Network (SIGN). SIGN 155 Pharmacological management of migraine. SIGN. http://www.sign.ac.uk.
  64. Silberstein SD, Saper JR, Freitag FG. Migraine diagnosis and treatment. In: Silberstein SD, Lipton RB, Dalessio DE, eds. Wolff’s Headache and Other Head Pain. 7th ed. Oxford, England: Oxford University Press; 2001. 121-237. :121-237.
  65. Wootton RJ, Wippold FJ II. Evaluation of headache in adults. UpToDate. https://www.uptodate.com. 26 Oct 2018.
  66. Worthington I, Pringsheim T, Gawel MJ, et al on behalf of the Canadian Headache Society Acute Migraine Treatment Guideline Development Group. Canadian Headache Society guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013 Sep;40(5)(Suppl 3):S1-S80. PMID: 23968886
  67. Cutrer FM. Pathophysiology, clinical manifestations, and diagnosis of migraine in adults. UpToDate. https://www.uptodate.com. 05 Nov 2020.
  68. Garza I, Schwedt TJ. Chronic migraine. UpToDate. https://www.uptodate.com. 09 Dec 2020.
  69. Sacco S, Bendtsen L, Ashina M, et al. European headache federation guideline on the use of monoclonal antibodies acting on the calcitonin gene related peptide or its receptor for migraine prevention. J Headache Pain. 2019 Jan;20(1):6. doi: 10.1186/s10194-018-0955-y. Accessed 13 Feb 2021. PMID: 30651064
  70. Smith JH. Acute treatment of migraine in adults. UpToDate. https://www.uptodate.com. 21 Oct 2020. Accessed 13 Feb 2021.
  71. Smith JH. Preventive treatment of episodic migraine in adults. UpToDate. https://www.uptodate.com. 07 Jan 2021.
  72. Steiner TJ, Jensen R, Katsarava Z, et al. Aids to management of headache disorders in primary care (2nd edition): on behalf of the European Headache Federation and Lifting the Burden: the global campaign against headache. J Headache Pain. 2019 May;20(1):57. doi: 10.1186/s10194-018-0899-2. Accessed 13 Feb 2021. PMID: 31113373
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