Initiatives have led to new developments in guidelines used for migraine management in the last five years in both the USA and in the UK. The guidelines being referred to are the UK MIPCA guidelines, the US Headache Consortium Guidelines, and the US Primary Care Network Guidelines. The genetic study breakthrough was done at the Helsinki University, Finland and the Sanger Institute, in the UK.
UK MIPCA Guidelines
Issued by MIPCA in 1997, they advocate an individualized approach to patient management of migraines. Doctors are to take into consideration the nature of the patient’s migraine attacks, the impact the headache has on the ability of the individual to perform in every day life, and the demands the migraines place on the individual’s lifestyle.
A diagnostic assessment and careful history of all headaches is studied at the first appointment. If the individual is experiencing up to 4 migraines per month they are given acute therapy with a simple analgesic that either is in combination with an anti-emetic or an oral triptan if analgesics have not been effective in the past history from the patient.
Nasal spray or subcutaneous triptan are used when the patient is unable to withstand oral therapies or needs a fast therapeutic effect.
It is important to have a goal of treatment in place. Goals revolve around being free of pain or being able to function without pain.
Prophylactic treatment is recommended for patients with 4 or more attacks per month or when patients have failed on previous treatment plans. A migraine specialist may be needed.
U.S. Headache Consortium Guidelines
In the year 2000, the consortium published new practice guidelines. The new guidelines identified goals for successful migraine management. The new guidelines purpose is to reduce the frequency and severity as well as the disability of the migraine attacks.
The goals also are to improve the quality of life, prevent future migraines, avoid the escalation of acute medication usage and educating patients so they can better self-manage their migraines.
Educating the patients is key to achieving the goals. The guidelines also advocate the creation of an individualized treatment plan that is focused on the symptoms, severity, disability and personal needs of each patient.
The U.S. guideline, according to Curr Med Res Opin @ 2002 Librapharm Limited, starts with migraine diagnosis then leads to disability assessment, patient communication and education, individualized management, and then stratified care. Individualized management includes attack frequency, attack severity, degree of disability, non-headache symptoms, and patient participation.