Italian guidelines for primary headaches: 2012 revised version

Paola Sarchielli,Vincenzo Guidetti,Fabio Antonaci,Giorgio Sandrini,Giuseppe Nappi,Franco Granella,Maria Pia Prudenzano,Marcello Fanciullacci,Giorgio Zanchin,Lidia Savi,Giorgio Bono,Anna Ferrari,Cristina Tassorelli,Massimo Alessandri,Lorenzo Pinessi,Luigi Alberto Pini,Mario Guazzelli,Grazia Sances

doi:10.1007/s10194-012-0437-6

Abstract

The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105–190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version.

Highlights

Introduction and methodologyTen years after the first edition (2001), the Italian Society for the Study of Headaches (SISC) decided to update the diagnostic and therapeutic guidelines for primary headaches in adults, including migraine, and tension-type headache, trigeminal-autonomic cephalgias (TACs) and other primary headaches.This concise version synthetically reports only treatment aspects, referring to the International Headache Society classification (ICHD-II, 2004) and its Appendix for diagnostic criteria
The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105–190 (2001)
Level A: Two or more clinically controlled, randomize, doubleblind studies carried out according to good clinical practice (GCP) versus placebo or versus an active drug for which there is proven evidence of efficacy

Summary

Introduction and methodology

Ten years after the first edition (2001), the Italian Society for the Study of Headaches (SISC) decided to update the diagnostic and therapeutic guidelines for primary headaches in adults, including migraine, and tension-type headache, trigeminal-autonomic cephalgias (TACs) and other primary headaches. Intramuscular or intravenous formulations can be used in the treatment of attacks of severe intensity in which nausea and vomiting are prevailing and in the case in which other symptomatic drugs are contraindicated or sedation is needed They can be considered as single drugs for the treatment of migraine in particular clinical settings (i.e. emergency department). The Ad Hoc Committee has unanimously decided that this class of drugs does not represent a valid option for the symptomatic treatment of migraine attacks This is due to the lack of data demonstrating their effectiveness compared with other symptomatic drugs and because of the potential risk of abuse and developing a chronic headache [99].

III III III

Findings

References recommendation