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Consensus of the Hellenic Headache Society on the diagnosis and treatment of migraine
More than 0.6 million people suffer from disabling migraines in Greece causing a dramatic work loss, but only a small proportion of migraineurs attend headache centres, most of them being treated by non-experts. On behalf of the Hellenic Headache Society, we report here a consensus on the diagnosis...
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Published in: | Journal of headache and pain 2019-12, Vol.20 (1), p.113-113, Article 113 |
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creator | Kouremenos, Evangelos Arvaniti, Chrysa Constantinidis, Theodoros S. Giannouli, Ermioni Fakas, Nikolaos Kalamatas, Themistoklis Kararizou, Evangelia Naoumis, Dimitrios Mitsikostas, Dimos D. |
description | More than 0.6 million people suffer from disabling migraines in Greece causing a dramatic work loss, but only a small proportion of migraineurs attend headache centres, most of them being treated by non-experts. On behalf of the Hellenic Headache Society, we report here a consensus on the diagnosis and treatment of adult migraine that is based on the recent guidelines of the European Headache Federation, on the principles of Good Clinical Practice and on the Greek regulatory affairs. The purposes are three-fold: (1) to increase awareness for migraine in Greece; (2) to support Greek practitioners who are treating migraineurs; and (3) to help Greek migraineurs to get the most appropriate treatment. For mild migraine, symptomatic treatment with high dose simple analgesics is suggested, while for moderate to severe migraines triptans or non-steroidal anti-inflammatory drugs, or both, should be administered following an individually tailored therapeutic strategy. A rescue acute treatment option should always be advised. For episodic migraine prevention, metoprolol (50–200 mg/d), propranolol (40–240 mg/d), flunarizine (5–10 mg/d), valproate (500–1800 mg/d), topiramate (25–100 mg/d) and candesartan (16–32 mg/d) are the drugs of first choice. For chronic migraine prevention topiramate (100-200 mg/d), valproate (500–1800 mg/d), flunarizine (5–10 mg/d) and venlafaxine (150 mg/d) may be used, but the evidence is very limited. Botulinum toxin type A and monoclonal antibodies targeting the CGRP pathway (anti-CGRP mAbs) are recommended for patients suffering from chronic migraine (with or without medication overuse) who failed or did not tolerate two previous treatments. Anti-CGRP mAbs are also suggested for patients suffering from high frequency episodic migraine (≥8 migraine days per month and less than 14) who failed or did not tolerate two previous treatments. |
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On behalf of the Hellenic Headache Society, we report here a consensus on the diagnosis and treatment of adult migraine that is based on the recent guidelines of the European Headache Federation, on the principles of Good Clinical Practice and on the Greek regulatory affairs. The purposes are three-fold: (1) to increase awareness for migraine in Greece; (2) to support Greek practitioners who are treating migraineurs; and (3) to help Greek migraineurs to get the most appropriate treatment. For mild migraine, symptomatic treatment with high dose simple analgesics is suggested, while for moderate to severe migraines triptans or non-steroidal anti-inflammatory drugs, or both, should be administered following an individually tailored therapeutic strategy. A rescue acute treatment option should always be advised. For episodic migraine prevention, metoprolol (50–200 mg/d), propranolol (40–240 mg/d), flunarizine (5–10 mg/d), valproate (500–1800 mg/d), topiramate (25–100 mg/d) and candesartan (16–32 mg/d) are the drugs of first choice. For chronic migraine prevention topiramate (100-200 mg/d), valproate (500–1800 mg/d), flunarizine (5–10 mg/d) and venlafaxine (150 mg/d) may be used, but the evidence is very limited. Botulinum toxin type A and monoclonal antibodies targeting the CGRP pathway (anti-CGRP mAbs) are recommended for patients suffering from chronic migraine (with or without medication overuse) who failed or did not tolerate two previous treatments. Anti-CGRP mAbs are also suggested for patients suffering from high frequency episodic migraine (≥8 migraine days per month and less than 14) who failed or did not tolerate two previous treatments.</description><identifier>ISSN: 1129-2369</identifier><identifier>EISSN: 1129-2377</identifier><identifier>DOI: 10.1186/s10194-019-1060-6</identifier><identifier>PMID: 31835997</identifier><language>eng</language><publisher>Milan: Springer Milan</publisher><subject>Anti-Inflammatory Agents, Non-Steroidal - therapeutic use ; Antibodies, Monoclonal - therapeutic use ; Best practice ; Botulinum Toxins, Type A - therapeutic use ; Consensus ; Consensus Article ; Greece - epidemiology ; Headache ; Headaches ; Hellenic headache society ; Humans ; Internal Medicine ; Medical diagnosis ; Medical treatment ; Medicine ; Medicine & Public Health ; Migraine ; Migraine Disorders - diagnosis ; Migraine Disorders - drug therapy ; Migraine Disorders - epidemiology ; Neurology ; Pain Medicine ; Propranolol - therapeutic use ; Societies, Medical - standards ; Treatment ; Treatment Outcome ; Tryptamines - therapeutic use ; Valproic Acid - therapeutic use</subject><ispartof>Journal of headache and pain, 2019-12, Vol.20 (1), p.113-113, Article 113</ispartof><rights>The Author(s). 2019</rights><rights>The Journal of Headache and Pain is a copyright of Springer, (2019). All Rights Reserved. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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For episodic migraine prevention, metoprolol (50–200 mg/d), propranolol (40–240 mg/d), flunarizine (5–10 mg/d), valproate (500–1800 mg/d), topiramate (25–100 mg/d) and candesartan (16–32 mg/d) are the drugs of first choice. For chronic migraine prevention topiramate (100-200 mg/d), valproate (500–1800 mg/d), flunarizine (5–10 mg/d) and venlafaxine (150 mg/d) may be used, but the evidence is very limited. Botulinum toxin type A and monoclonal antibodies targeting the CGRP pathway (anti-CGRP mAbs) are recommended for patients suffering from chronic migraine (with or without medication overuse) who failed or did not tolerate two previous treatments. 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epidemiology</subject><subject>Neurology</subject><subject>Pain Medicine</subject><subject>Propranolol - therapeutic use</subject><subject>Societies, Medical - standards</subject><subject>Treatment</subject><subject>Treatment Outcome</subject><subject>Tryptamines - therapeutic use</subject><subject>Valproic Acid - therapeutic use</subject><issn>1129-2369</issn><issn>1129-2377</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp1kstu1TAQhiMEoqXwAGxQJDZsAr7Etw0SOgJaqRIL6NqaOJPUR4ld7KRS3x6fphwoEht7NPPN75nxVNVrSt5TquWHTAk1bVOOhhJJGvmkOqWUmYZxpZ4ebWlOqhc57wlhhGvxvDrhVHNhjDqtrnYxZAx5zXUc6uUa63OcJgzeFQN6cMXzPTqPy10dwz3QexhDzD7XEPp6SQjLjGE55M9-TOADvqyeDTBlfPVwn1VXXz7_2J03l9--Xuw-XTZOcLmU0nirupYJ1rYSlBIGNB00uAE7pnTvWEcdEic5QicGxrU21DGkGnrlkPOz6mLT7SPs7U3yM6Q7G8Hbe0dMo4W0eDehJRrQGdEJ0YqWk14zRUB3RLihGwbXF62Pm9bN2s3Yu9JSgumR6ONI8Nd2jLdWmjJn3RaBdw8CKf5cMS929tmVaULAuGZbuiWcC05FQd_-g-7jmkIZVaGYkEYZwQpFN8qlmHPC4VgMJfawAHZbAFsOe1gAK0vOm7-7OGb8_vECsA3IJRRGTH-e_r_qL0DBu7U</recordid><startdate>20191213</startdate><enddate>20191213</enddate><creator>Kouremenos, Evangelos</creator><creator>Arvaniti, Chrysa</creator><creator>Constantinidis, Theodoros S.</creator><creator>Giannouli, Ermioni</creator><creator>Fakas, Nikolaos</creator><creator>Kalamatas, Themistoklis</creator><creator>Kararizou, Evangelia</creator><creator>Naoumis, Dimitrios</creator><creator>Mitsikostas, Dimos D.</creator><general>Springer Milan</general><general>Springer Nature B.V</general><general>BMC</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20191213</creationdate><title>Consensus of the Hellenic Headache Society on the diagnosis and treatment of migraine</title><author>Kouremenos, Evangelos ; Arvaniti, Chrysa ; Constantinidis, Theodoros S. ; Giannouli, Ermioni ; Fakas, Nikolaos ; Kalamatas, Themistoklis ; Kararizou, Evangelia ; Naoumis, Dimitrios ; Mitsikostas, Dimos D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c536t-23347b4252446a7759a81f8acfeb278dc2b1ce0c63eab5f238891c2e18ad7ce33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Anti-Inflammatory Agents, Non-Steroidal - 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On behalf of the Hellenic Headache Society, we report here a consensus on the diagnosis and treatment of adult migraine that is based on the recent guidelines of the European Headache Federation, on the principles of Good Clinical Practice and on the Greek regulatory affairs. The purposes are three-fold: (1) to increase awareness for migraine in Greece; (2) to support Greek practitioners who are treating migraineurs; and (3) to help Greek migraineurs to get the most appropriate treatment. For mild migraine, symptomatic treatment with high dose simple analgesics is suggested, while for moderate to severe migraines triptans or non-steroidal anti-inflammatory drugs, or both, should be administered following an individually tailored therapeutic strategy. A rescue acute treatment option should always be advised. For episodic migraine prevention, metoprolol (50–200 mg/d), propranolol (40–240 mg/d), flunarizine (5–10 mg/d), valproate (500–1800 mg/d), topiramate (25–100 mg/d) and candesartan (16–32 mg/d) are the drugs of first choice. For chronic migraine prevention topiramate (100-200 mg/d), valproate (500–1800 mg/d), flunarizine (5–10 mg/d) and venlafaxine (150 mg/d) may be used, but the evidence is very limited. Botulinum toxin type A and monoclonal antibodies targeting the CGRP pathway (anti-CGRP mAbs) are recommended for patients suffering from chronic migraine (with or without medication overuse) who failed or did not tolerate two previous treatments. Anti-CGRP mAbs are also suggested for patients suffering from high frequency episodic migraine (≥8 migraine days per month and less than 14) who failed or did not tolerate two previous treatments.</abstract><cop>Milan</cop><pub>Springer Milan</pub><pmid>31835997</pmid><doi>10.1186/s10194-019-1060-6</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Antibodies, Monoclonal - therapeutic use Best practice Botulinum Toxins, Type A - therapeutic use Consensus Consensus Article Greece - epidemiology Headache Headaches Hellenic headache society Humans Internal Medicine Medical diagnosis Medical treatment Medicine Medicine & Public Health Migraine Migraine Disorders - diagnosis Migraine Disorders - drug therapy Migraine Disorders - epidemiology Neurology Pain Medicine Propranolol - therapeutic use Societies, Medical - standards Treatment Treatment Outcome Tryptamines - therapeutic use Valproic Acid - therapeutic use |
title | Consensus of the Hellenic Headache Society on the diagnosis and treatment of migraine |
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