Abstract
BackgroundGlobally, 3 billion people suffer from either migraine or tension-type headache disorder over their lifetime. Approximately 50% of American adults suffering from headache or migraine have used complementary and alternative medicine (CAM), however, the quality and quantity of recommendations associated with such therapies across clinical practice guidelines (CPGs) for the treatment and/or management of these conditions are unknown. The purpose of this study was to identify the quantity and assess the quality of such CAM recommendations.MethodsMEDLINE, EMBASE and CINAHL were systematically searched from 2009 to April 2020; the Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched for eligible CPGs. CPGs were included if they provided any therapy recommendations. Eligible CPGs included those written for adult patients with headache and migraine; CPGs containing CAM recommendations were assessed twice for quality using the AGREE II instrument, once for the overall CPG and once for the CAM sections.ResultsOf 486 unique search results, 21 CPGs were eligible and quality assessed; fifteen CPGs mentioned CAM, of which 13 CPGs made CAM recommendations. The overall CPG assessment yielded higher scaled domain percentages than the CAM section across all domains. The results from highest to lowest were as follows (overall, CAM): clarity of presentation (66.7% vs. 50.0%), scope and purpose (63.9% vs. 61.1%), stakeholder involvement (22.2% vs. 13.9%), rigour of development (13.5% vs. 9.4%), applicability (6.3% vs. 0.0%), and editorial independence (0.0% vs. 0.0%).ConclusionsOf the eligible CPGs, the CAM sections were of lower quality compared to the overall recommendations across all domains of the AGREE II instrument. CPGs that scored well could serve as a framework for discussion between patients and healthcare professionals regarding use of CAM therapies in the context of headache and migraine.
Highlights
3 billion people suffer from either migraine or tension-type headache disorder over their lifetime
This study described the quantity and quality of headache and/or migraine Clinical Practice Guideline (CPG) that included complementary and alternative medicine (CAM) recommendations, revealing that several CPGs can be used to support informed decision-making among healthcare professionals to better inform and support their patients
The CPGs included in this study provided CAM-specific recommendations related to subsets of CAM therapies, including dietary supplements, oxygen therapy, herbal medicine, electrotherapy, and acupuncture
Summary
3 billion people suffer from either migraine or tension-type headache disorder over their lifetime. The different types of headache disorders are defined, diagnosed and screened for according to the ICHD, currently in its third edition published in 2018 [4], following the publication of the first two editions [5, 6] This first version was published in 1988 and mainly based on expert opinions, while the ICHD-II published in 2004 contained a variety of improvements, partly due to new research and partly due to updated expert opinions. New scientific evidence played a comparatively greater role in the improvements made to the ICHD-3 beta, and all other changes included in the ICHD-3 were based on this evidence Since this time, it has been found that the ICHD-3 is significantly more specific than the ICHD-3 beta for the diagnosis of migraine with aura and with typical aura [4, 8, 9]
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