Rapid Reference to Migraine

Introduction and background * Introduction to headache in primary care * Headaches commonly encountered in primary care Migraine Tension-type headache Short, sharp headaches Cluster headache Sinus headache and other causes of facial pain Secondary (sinister) headaches * Introduction to migraine Migraine sub-types Definition and epidemiology * The natural history (five phases) of a migraine attack Prodrome, aura, headache, resolution, recovery Risk factors and trigger factors * Epidemiology of migraine Incidence and prevalence Effect of gender, race, income and other social and demographic factors * Burden of illness due to migraine Burden to the patient (symptomatology, disability, quality of life) Burden to society (direct and indirect costs of care) * Aetiology Genetic factors Neurovascular hypothesis Diagnosis * IHS criteria Criteria for use in primary care * Differential diagnosis of migraine from other headache disorders Management of migraine * The current status of migraine management in primary care Under-consultation, under-diagnosis and under-treatment * Management guidelines for migraine Introduction to MIPCA, US Headache Consortium and US Primary Care Net guidelines General principles of management Patient counselling and buy-in Careful diagnosis Assessment of migraine impact Production of an individualized treatment plan Follow-up Current 'hot topics' of management * Is a diagnosis essential? * Early versus late treatment * Necessity for new guidelines * Management of chronic daily headache Migraine treatment * Introduction When to use acute and prophylactic medications Use of evidence-based medicine versus the 'real world' situation * Acute treatments for migraine Analgesics and analgesic combinations Efficacy and side effect profiles Ergotamine and DHE Efficacy and side effect profiles Triptans Mode of action Available triptans and formulations * Efficacy and side effect profiles * Comparison of the triptans, based on available evidence Other acute medications that are available in certain countries only (e.g. Stadol in USA) Recommendations for the choice of medication and how to use it * Prophylactic treatments for migraine Beta-blockers 5-HT2 antagonists Tricyclic antidepressants and SSRIs Sodium valproate Over-the-counter prophylactics (vitamin B2, magnesium, feverfew and aspirin) Other acute medications that are available in certain countries only (e.g. calcium antagonists) Recommendations for the choice of medication and how to use it * Non-pharmacological treatments for migraine Biofeedback and relaxation Acupuncture Homeopathy * Treatment for chronic daily headache Management of migraine in the primary care setting * Overall summary of the previous two sections * Role of the patient, pharmacist, nurse, GP and specialist Frequently asked questions * By the GP to the specialist * By the patient to the GP Future developments in migraine management References Appendices * List of available drugs and contraindications, side effects, cost implications * Useful addresses and websites for the GP and the patient Professional societies and journals Patient support organizations and charities Index