Greek Researchers Outline New Consensus on Diagnosis and Treatment of Migraine

On behalf of the Hellenic Headache Society, a group of Greek researchers reported a consensus on the diagnosis and treatment of adult migraines in The Journal of Headache and Pain on December 13.

Taking into consideration recent guidelines put out by the European Headache Federation (EHF), the researchers outlined treatments for those suffering from mild, moderate, severe, episodic, and chronic migraines, along with additional preventive measures.

As the third most prevalent disorder in the world, 1.04 billion people were estimated to suffer from migraines in 2016. It is the top cause of disability in individuals under 50, according to researchers, and because of the high cost of treatment “migraine is a prominent health-related driver of economic losses for the European Union.”

To reach the consensus, members of the Hellenic Headache Society took into consideration recommendations from the EHF, the European Federation of Neurological Societies, and patient preferences collected from its own previous studies. National Pharmacy Affairs rules for treatment reimbursement were also included in the research.

According to the researchers, because “no biomarkers exist” for the diagnosis of migraine, “taking the patient’s medical history remains the most important part of the diagnostic procedure.”

To avoid leaving out information, which can lead to misdiagnosis, the Hellenic Headache Society advises providers to utilize semistructured interviews when determining diagnoses. The interviews include inquiries into the headache onset, duration, localization, severity, frequency, pain characteristics, pattern, and possible trigger causes. Physical factors such as blood pressure measurements, body mass index, and fundoscopy for papilledema are also recommended.

When it comes to treatment of specific migraines, researchers compiled the following treatment guidelines:

• For mild migraine: symptomatic treatment with high dose simple analgesics
• For moderate to severe migraine: Triptans or non-steroidal anti-inflammatory drugs or both should be administered following an individually tailored therapeutic strategy, including a rescue acute treatment option
• For episodic migraine prevention: First choice drugs include metoprolol (50-200 mg/day), propranolol (40-240 mg/day), flunarizine (5-10 mg/day), valproate (500-1800 mg/day), topiramate (25-100 mg/day), and candesartan (16-32 mg/day)
• For chronic migraine prevention: Evidence is limited, but topiramate (100-200 mg/day), valproate (500-1800 mg/day), flunarizine (5-10 mg/day), and venlafaxine (150 mg/day) may be used
• For patients suffering from chronic migraine who failed or did not tolerate 2 previous treatments: botulinum toxin type A and monoclonal antibodies targeting the CGRP pathway (anti-CGRP mABs)

In addition, the researchers suggest 2 new options to incorporate into migraine care. The first is to add a rescue medication in the symptomatic migraine treatment. The second is to introduce early prophylactic treatment in order to prevent migraine chronification and overuse of medication.

Overall, the researchers hope their findings will assist medical professionals and patients in the future.

“The consensus outlined here represents an additional effort…to provide a practical tool including both established and novel treatments for headache and migraine in particular, which can easily be used by neurologists, general practitioners, and any other health professional involved in headache medicine,” they said.

Reference

Kouremenos E, Arvaniti C, Constantinidis TS, et al. Consensus of the Hellenic Headache Society on the diagnosis and treatment of migraine. J Headache Pain. 2019;20(1):113. doi: 10.1186/s10194-019-1060-6.