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Doctors' Groups Issue Migraine Guidelines
Excerpt
By Amanda Gardner, HealthScoutNews
(HealthScoutNews)
-- The nation's two largest groups of primary care physicians
are issuing their first set of guidelines for the prevention and
treatment of migraines.
The guidelines, formulated by the
American College of Physicians-American Society of Internal Medicine
(ACP-ASIM) and the American Academy of Family Physicians (AAFP)
and directed to physicians, recommend aspirin or ibuprofen as
the first line of therapy.
Normally, migraine guidelines are
put out by neurologists. When the ACP-ASIM conducted a survey
in the mid 1990s of the topics its members would like to see guidelines
on, headaches topped the list.
"It's a very common complaint
in primary care," says Dr. Vincenza Snow, senior medical
associate in ACP-ASIM's department of scientific policy. Primary
care is where most migraine sufferers first encounter the health
care system.
According to the new guidelines,
published in today's issue of Annals of Internal Medicine,
28 million Americans suffer from these severe, recurring headaches,
representing 18 percent of all women and 6.5 percent of all men.
About half of these people have not been diagnosed or remain undertreated.
The guidelines were based on an
extensive review of the existing medical literature by representatives
from the fields of emergency medicine, internal medicine, neurology
and other disciplines.
"These guidelines are really
evidence-based, which means they were really crafted only after
a really rigorous review of the medical literature," says
Dr. Eric Wall, a family physician from Portland, Ore., who represented
the American Academy of Family Physicians in the development of
the guidelines. "We really had to hammer it out."
The guidelines may be more conservative
than many people would like, Wall concedes, but this is only a
reflection of the available literature.
"Some people will say it doesn't
go far enough, that it doesn't address new treatments, new therapies,"
he says. "It is fairly conservative in its recommendations
but, unfortunately, that really reflects the state of the science
right now."
Conservative or not, here is what
the multidisciplinary team has recommended:
- The first line of therapy should
be nonsteroidal anti-inflammatory drugs (NSAIDS), with the most
reliable appearing to be the over-the-counter stalwarts aspirin
and ibuprofen. There is no proof that acetaminophen on its own
is effective for migraines. "People need to be taking the
right kind of over-the-counter medications," says Snow.
"Not all of them are good for migraine."
- If these drugs don't work, patients
and physicians should move on to drugs specifically developed
for migraines, such as triptans or DHE nasal spray.
- If patients have nausea or vomiting,
non-oral remedies should be tried first. Nausea and vomiting
should also be treated directly.
- People who have repeated migraines
should be evaluated for possible preventive therapy. Generally,
good candidates for preventive measures are patients who have
two or more migraines that last three or more days each month;
fail to respond to migraine treatment; use medication more than
twice a week; or have "uncommon" migraine conditions
such as aura (visual sensations).
- Migraine sufferers should be
actively involved in formulating their own treatment plan, the
guidelines says. And they should chart their headaches and identify
and avoid triggers such as alcohol, chocolate, caffeine, foods
containing additives (MSG, tyramine or nitrates), sleep loss,
stress and perfumes.
What To Do
For more on migraines, visit the
JAMA
Migraine Information Center or the National
Library of Medicine.
Reference
Source 101
For more information on how to prevent other diseases, use
PreventDisease.com's "Quick
Prevention Resources".
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