Study on management of pediatric migraine by general practitioners in northern France

Abstract

The study explored the awareness of the Haute Autorité de Santé (High Health Authority, HAS) guidelines for migraine management in children among a random sample of 100 general practitioners (GPs) dichotomised in an urban and a rural group. A questionnaire conducted by phone included questions on knowledge of pediatric migraine acute treatment and preventive therapy, referral to a child neurologist as well as GPs awareness of HAS recommendations in general. Although 45% of GPs argued they were prescribing ibuprofen as first-line abortive drug, only 3% were aware of the recommended dose. Only 48% of GPs were agreeing to initiate preventive therapy. Fifty percent of GPs stated that they knew HAS guidelines but only 24% stated that they had read them. The only significant difference between urban and rural GPs concerned the initiation of preventive therapy. Continuing educational programmes on the implementation of pediatric migraine guidelines is strongly needed.Electronic supplementary materialThe online version of this article (doi:10.1007/s10194-009-0111-9) contains supplementary material, which is available to authorized users.

Chronic migraine: comorbidities, risk factors, and rehabilitation

“…The more common psychiatric conditions related to migraine are depression, bipolar disorders, generalized anxiety disorders and somatoform disorders. Such comorbidities proved to be present in migraine patients than in tension-headache patients, being present both in children and in adults and occasionally influencing related therapeutic strategies [35,36].…”

Primary Headache in Children and Adolescents: Update on Pharmacotherapy of Migraine and Tension-Type Headache

“…Concerning preventive pharmacologic therapy of migraine, about onethird of adolescents meet the criteria, although only 10 to 19% are offered prophylaxis. 16,22 Efforts to make effective prophylactics available to all patients are evidently necessary. Also, novel prevention options with reasonable safety profiles must not be generally denied to children and adolescents, because they may imply an important benefit in the long term, taking into account the putative mechanisms of action.…”

“…20,21 Prophylaxis should also be considered if acute treatment options are ineffective, not tolerated, contraindicated, or regularly overused and in patients prone to extremely intensive, prolonged (> 48 hours), hemiplegic, or basilar-type migraine or severe aura. 14,19,22 Prophylaxis can be appropriate in patients prone to frequent episodic TTH and should be discussed in patients suffering chronic TTH (CTTH). 23,24 In general, pharmacologic prophylaxis is only indicated if lifestyle modification and nonpharmacologic measures have been ineffective.…”

Migraine in childhood: best practices

“…Quarante-cinq pour cent des médecins prescrivaient de l'ibuprofène en première intention, mais seulement 3 % connaissaient les doses recommandées [14].…”