Revised French guidelines for the diagnosis and management of migraine in adults and children

Abstract

Background Sponsor These revised guidelines were prepared at the request of the Société Française d'Etude des Migraines et des Céphalées (SFEMC; French Society for the Study of Migraine Headache). They are a revision of the professional guidance on the "Diagnosis and therapeutic management of migraine in adults and children: clinical and economic aspects" published by the ANAES in 2002 and revised in 2012. Scope of the guidlines. These guidelines concern the overall management of migraine, diagnostic and therapeutic strategies, economic aspects of the disease and its treatments, menstrual (catamenial) migraine, migraine in pregnancy, migraine and oral contraception, migraine and the menopause. Headaches other than migraine will not be discussed except in the context of differential diagnosis. Other subjects not discussed in these guidelines include diseases associated with migraine apart from psychiatric problems, risk factors, migraine and smoking, chronic migraine rare forms and complications of migraine. Patients concerned by the guidelines These guidelines concern adults and children. Professionals concerned by the guidelines

New advances in prevention of migraine

“…Relaxation, biofeedback, and cognitive behavioral therapy are recommended and effective (grade A evidence). They can improve the patient’s quality of life 4,6. Studies evaluating acupuncture are inconclusive, while homeopathy is proved to be ineffective (grade A evidence) 4…”

“…3 However, these criteria have a poor sensitivity, so strict adherence may lead to migraine under diagnosis. Therefore, “probable migraine without aura” is used for patients who fulfill all criteria except one 4. Migraine disorders also include hemiplegic migraine, chronic migraine, menstrual-related migraine (MRM), and complicated migraine.…”

“…Tension headache, unlike migraine, is bilateral, has a pressing character, and is not aggravated by ordinary activities. However, a single patient may have both migraine and tension headache 4. Cluster headaches are differentiated from migraine in that they are commonly unilateral, surrounding an eye and associated with eye redness or nasal congestion 6…”

“…Nevertheless, some situations require further evaluation, as in patients presenting with: sudden onset headache, first presentation after age of 50, atypical aura, neurological deficit, impaired level of consciousness, progressive headache, or change from a preexisting pattern, or headache with unexplained fever 4-6…”

Migraine et contraception

“…Des traitements spé cifiques de la crise, qui diminue l'inflammation neurogè ne et la vasodilation ont é galement fait preuve de leur efficacité : il s'agit des triptans et des dé rivé s de l'ergot de seigle (tartrate d'ergotamine ou la dihydroergotamine [per-nasale ou injectable]) [31].…”