GUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF MIGRAINE IN CLINICAL-PRACTICE

Objective: To provide physicians and allied health care professionals with guidelines for the diagnosis and management of migraine in clinic al practice. Options: The full range and quality of diagnostic and the rapeutic methods available for the management of migraine. Outcomes: I mprovement in the diagnosis and treatment of migraine, which will lead to a reduction in suffering, increased productivity and decreased eco nomic burden. Evidence and values: The creation of the guidelines foll owed a needs assessment by members of the Canadian Headache Society an d included a statement of objectives; development of guidelines by mul tidisciplinary working groups using information from literature review s and other resources; comparison of alternative clinical pathways and description of how published data were analysed; definition of the le vel of evidence for data in each case; evaluation and revision of the guidelines at a consensus conference held in Ottawa on Oct. 27-29, 199 5; redrafting and insertion of tables showing key variables and data f rom various studies and tables of data with recommendations; and reass essment by all conference participants. Benefits, harms and costs: Acc uracy in diagnosis is a major factor in improving therapeutic effectiv eness; Improvement in the precise diagnosis of migraine, coupled with a rational plan for the treatment of acute attacks and for prophylacti c therapy, is likely to lead to substantial benefits in both human and economic terms. Recommendations: The diagnosis of migraine can be imp roved by using modified criteria of the International Headache Society as well as a semistructured patient interview technique. Appropriate treatment of symptoms should take into account the severity of the mig raine attack, since most patients will have attacks of differing sever ity and can learn to use medication appropriate for each attack. When headaches are frequent or particularly severe, prophylactic therapy sh ould be considered. Both the avoidance of migraine trigger factors and the application of nonpharmacological therapies play important roles in overall migraine management and will be addressed at a later date. Validation: The guidelines are based on consensus of Canadian experts in neurology, emergency medicine, psychiatry, psychology, family medic ine and pharmacology, and consumers. Previous guidelines did not exist . Field testing of the guidelines is in progress. Sponsors: Support fo r the consensus conference was provided by an unrestricted educational grant from Glare Wellcome Inc. Editorial coordination was provided by Medical Education Programs Canada Inc.