Migraine Clinical Guidelines and Treatment

In the absence of a cure for migraine, the aims of migraine management at primary care level are:

  • The successful treatment of the migraineur’s acute attack
  • The prevention and limitation of future attacks
  • To encourage migraine sufferers to continue with their care
  • The identification and referral of the minority of patients who need specialist services

The Stratified Care approach

The Stratified Care approach is the approach of choice when treating headache disorders, whereby the doctor decides what treatment is necessary based on the evidence for that treatment and the individual patient’s needs. Recent best practice guidelines on the management of migraine such as the Migraine in Primary Care Advisors (MIPCA) guidelines from the UK, the US Headache Consortium, and the Primary Care Network guidelines are based on the Stratified Care model.

‘Stratified Care’ has now largely superceded the ‘stepped care’ approach which began with analgesics (perhaps with an anti-emetic) for all patients regardless of headache impact, severity or frequency, and if those are not effective, the patient is “stepped up” to the next level of treatment, reserving the more powerful triptans as third-line options.

Under a stratified approach:

  • Each patient should have an individual treatment plan, based on factors such as headache frequency, duration and severity, non-headache symptoms, the impact it has on the patient’s life and the patient’s own history and preference.
  • Migraine specific treatments should be provided from the start if necessary. Rescue medication is recommended in case the initial therapy fails.

The MIDAS and Headache Impact Test (HIT) tests can be useful for helping the doctor implement a stratified treatment plan.

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Migraine Clinical Guidelines and Treatment

In the absence of a cure for migraine, the aims of migraine management at primary care level are:

  • The successful treatment of the migraineur’s acute attack
  • The prevention and limitation of future attacks
  • To encourage migraine sufferers to continue with their care
  • The identification and referral of the minority of patients who need specialist services

The Stratified Care approach

The Stratified Care approach is the approach of choice when treating headache disorders, whereby the doctor decides what treatment is necessary based on the evidence for that treatment and the individual patient’s needs. Recent best practice guidelines on the management of migraine such as the Migraine in Primary Care Advisors (MIPCA) guidelines from the UK, the US Headache Consortium, and the Primary Care Network guidelines are based on the Stratified Care model.

‘Stratified Care’ has now largely superceded the ‘stepped care’ approach which began with analgesics (perhaps with an anti-emetic) for all patients regardless of headache impact, severity or frequency, and if those are not effective, the patient is “stepped up” to the next level of treatment, reserving the more powerful triptans as third-line options.

Under a stratified approach:

  • Each patient should have an individual treatment plan, based on factors such as headache frequency, duration and severity, non-headache symptoms, the impact it has on the patient’s life and the patient’s own history and preference.
  • Migraine specific treatments should be provided from the start if necessary. Rescue medication is recommended in case the initial therapy fails.

The MIDAS and Headache Impact Test (HIT) tests can be useful for helping the doctor implement a stratified treatment plan.

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Prophylactic Treatments for Migraine

Prophylactic Treatments for Migraine The role of prevention is to achieve a reduction in the frequency, severity and duration of attacks.  Effective prophylaxis can achieve up to a 50% reduction in the frequency in approximately 50% of...[read more]

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General Information on Triptan Therapy

Triptan Therapy: There are seven Triptans available in Ireland. Almotriptan 12.5 mg orally Frovatriptan 2.5 mg orally Sumatriptan 50 mg / 100 mg orally; 20 mg/ 40 mg intranasally; mg subcutaneously (on a named patient basis)...[read more]

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Migraine Prophylaxis There are no sound criteria for preferring one prophylactic drug over another. However, the following should be taken into account (1) Comorbidities  (2) Drug interactions (3) Possible side effects (4) Lifestyle issues e.g. a...[read more]

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Options in Migraine Prophylaxis

Migraine Prophylaxis β-Blockers The β-Blockers have been used for prophylaxis for more than 25 years and continue to be a strong option unless contraindicated in patients with asthma or peripheral vascular disease. Propranolol 80mg - 160mg is...[read more]

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Chronic Daily Headache

Chronic Daily Headache Successful management of CDH depends on: Identification of the cause of the CDH  e.g. medication reliance, co-morbidities, injury. Commitment from patient and doctor. There is no simple answer so a thorough approach to...[read more]

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