Diagnosis and management of migraine in ten steps

Abstract

Migraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.

The management and clinical knowledge of headache disorders among general practitioners in Norway: a questionnaire survey

“…Neuroimaging is not an essential part of headache investigations and should be reserved for those with red flags indicating secondary headaches [ 12 , 25 ]. Several studies have shown that neuroimaging is routinely ordered despite a typical headache history and normal clinical examination [ 26 , 27 ].…”

“…Effective treatments exist for the most common primary headache disorders, migraine and tension-type headache [ 12 , 29 ]. About one in three GPs reported that they had good knowledge about migraine and TTH, and > 96% reported good or medium knowledge about migraine and TTH.…”

“…The vast majority suggested triptans for acute treatment of migraine and adequate prophylactic medication was suggested for frequent episodic migraine by as many as 87%. Candesartan and beta-blockers are two of the first line choices in most treatment guidelines and were the most commonly suggested prophylactic medications [ 12 – 14 , 30 ]. Few GPs suggested topiramate and Botulinum toxin type A. Topiramate has class I evidence and should probably be used more by patients with migraine.…”

“…However, for this to function, it is imperative that the GP has sufficient knowledge and validated tools for everyday use. The burden of headache and migraine is high and the findings suggest that diagnosis and management in the health care system is still limited [ 10 – 12 ]. International guidelines and National recommendations for diagnosis and management developed by the National Advisory Unit on Headache in Norway exist [ 12 – 15 ], but data is very limited on how GPs actually experience and manage headache patients [ 16 , 17 ].…”

“…The burden of headache and migraine is high and the findings suggest that diagnosis and management in the health care system is still limited [ 10 – 12 ]. International guidelines and National recommendations for diagnosis and management developed by the National Advisory Unit on Headache in Norway exist [ 12 – 15 ], but data is very limited on how GPs actually experience and manage headache patients [ 16 , 17 ]. In the present exploratory descriptive study we investigate the knowledge among Norwegian GPs about headache and the clinical management of patients with headache.…”