E-drug: migraine management
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Note from the moderator:
This is the first summarized abstract from the E-drug literature group.
Joel Lexchin kindly offered to review the Canadian Medical Journal
for E-drug.
More reviewers are welcome!
Wilbert Bannenberg, E-drug moderator
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Guidelines for the diagnosis and management of migraine in clinical practice
William E.M. Pryse-Phillips, MD; David W. Dodick, MD; John
G. Edmeads, MD; Marek J. Gawel, MD; Robert F. Nelson, MD;
R. Allan Purdy, MD; Gordon Robinson, MD; Denise Stirling,
MD; Irene Worthington, BScPhm
Can Med Assoc J 1997;156:1273-87
Abstract
Objective: To provide physicians and allied health care
professionals with guidelines for the diagnosis and management of
migraine in clinical practice.
Options: The full range and quality of diagnostic and therapeutic
methods available for the management of migraine.
Outcomes: Improvement in the diagnosis and treatment of
migraine, which will lead to a reduction in suffering, increased
productivity and decreased economic burden.
Evidence and values: The creation of the guidelines followed a
needs assessment by members of the Canadian Headache Society
and included a statement of objectives; development of guidelines
by multidisciplinary working groups using information from
literature reviews and other resources; comparison of alternative
clinical pathways and description of how published data were
analysed;
definition of the level of evidence for data in each case; evaluation
and revision of the guidelines at a consensus conference held in
Ottawa on Oct. 27-29, 1995; redrafting and insertion of tables
showing key variables and data from various studies and tables of
data with recommendations; and reassessment by all conference
participants.
Benefits, harms and costs: Accuracy in diagnosis is a major
factor in improving therapeutic effectiveness. Improvement in the
precise diagnosis of migraine, coupled with a rational plan for the
treatment of acute attacks and for prophylactic therapy, is likely to
lead to substantial benefits in both human and economic terms.
Recommendations: The diagnosis of migraine can be improved
by using modified criteria of the International Headache Society as
well as a semistructured patient interview technique. Appropriate
treatment of symptoms should take into account the severity of the
migraine attack, since most patients will have attacks of differing
severity and can learn to use medication appropriate for each
attack. When headaches are frequent or particularly severe,
prophylactic therapy should be considered. Both the avoidance of
migraine trigger factors and the application of nonpharmacological
therapies play important roles in overall migraine management and
will be addressed at a later date.
Validation: The guidelines are based on consensus of Canadian
experts in neurology, emergency medicine, psychiatry,
psychology, family medicine and pharmacology, and consumers.
Previous guidelines did not exist. Field testing of the guidelines is
in progress.
Sponsors: Support for the consensus conference was provided
by an unrestricted educational grant from Glaxo Wellcome Inc.
Editorial coordination was provided by Medical Education
Programs Canada Inc.
Joel Lexchin MD
121 Walmer Rd.
Toronto, Ontario
CANADA M5R 2X8
Phone: (416)-964-7186
Fax: (416)-923-9515
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