Consensus of the Hellenic Headache Society on the diagnosis and treatment of migraine

Evangelos Kouremenos,Dimitrios Naoumis,Ermioni Giannouli,Chrysa Arvaniti,Nikolaos Fakas,Theodoros S Constantinidis,Themistoklis Kalamatas,Dimos D Mitsikostas,Evangelia Kararizou

doi:10.1186/s10194-019-1060-6

Abstract

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.

Highlights

Migraine is the third most prevalent disorder in the world [1] and the first cause of disability in under 50s [2]
The consensus outlined here represents an additional effort of the Headache Society (HHS) to provide a practical tool including both established and novel treatments for headache and migraine in Kouremenos et al The Journal of Headache and Pain (2019) 20:113 particular, which can be used by Neurologists, General Practitioners and any other health professional involved in headache medicine
The European Federation of Neurological Societies (EFNS) recommendations for migraine [8] and medication overuse headache [9] were reviewed and additional literature search was performed for updating the treatments, following the methodology described by EFNS task forces

Summary

Introduction

Migraine is the third most prevalent disorder in the world [1] and the first cause of disability in under 50s [2]. All migraineurs should be educated by their treating physicians to limit the use of symptomatic anti-migraine drugs to a maximum of two days per week if they use triptans, or combinations of drugs, or three days per week if they use NSAIDs or simple analgesics, in order to avoid medication overuse headache (since the related ICHD-3 limits are 10 and 15 days/month [11], by this suggestion we prevent from medication overuse securely).

Results

Conclusion