The Development of Evidence-Based Guideline for Diagnosis and Management of Headache in Korea

Abstract

Objective We aimed to develop the clinical guideline for headache by the systematic review and synthesis of existing evidence-based guidelines. The purpose of developing the guideline was to improve the appropriateness of diagnosis and treatment of headache disorder, and consequently, to improve patients’ pain control and quality of life. The guideline broadly covers the differential diagnosis and treatment of tension-type headache, migraine, cluster headache, and medication-overuse headache. Methods This is a methodological study based on the ADAPTE methodology, including a systematic review of the literature, quality assessment of the guidelines using the Appraisal of Clinical Guidelines for REsearch & Evaluation II (AGREE II) Instrument, as well as an external review using a Delphi technique. The inclusion criteria for systematic search were as follows: topic-relevant, up-to-date guidelines including evidence from within 5 years, evidence-based guidelines, guidelines written in English or Korean, and guidelines issued by academic institutions or government agencies. Results We selected five guidelines and conducted their quality assessment using the AGREE II Instrument. As a result, one guideline was found to be eligible for adaptation. For 13 key questions, a total of 39 recommendations were proposed with the grading system and revised using the nominal group technique. Conclusion Recommendations should be applied to actual clinical sites to achieve the ultimate goal of this guideline; therefore, follow-up activities, such as monitoring of guideline usage and assessment of applicability of the recommendations, should be performed in the future. Further assessment of the effectiveness of the guideline in Korea is needed.

Identifying Outcome Measures for Migraine Value‐Based Contracting Using the Delphi Method

“…Several studies have utilized the Delphi method to achieve consensus on clinical decision-making and outcomes for migraine, although none aimed to identify meaningful and measurable outcomes to incorporate into a pharmaceutical value-based contract. 27,[43][44][45][46][47] Some of these studies focused on improving medical communication in migraine management 42 and determining which physical examinations were the most useful for patients with headache. 43,45 Another study assessed outcome measures for determining the effectiveness of non-pharmacological interventions, and 29- †Non-patient and non-employer participants responded to prompt, "Please rate each measure below on how feasible they are to collect in an integrated delivery and finance system where both administrative claims and EHR data are accessible."…”

“…Several studies have utilized the Delphi method to achieve consensus on clinical decision‐making and outcomes for migraine, although none aimed to identify meaningful and measurable outcomes to incorporate into a pharmaceutical value‐based contract 27,43‐47 . Some of these studies focused on improving medical communication in migraine management 42 and determining which physical examinations were the most useful for patients with headache 43,45 .…”