Guideline for Management of Primary Headache in Adults

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Guideline for Management of Primary Headache in Adults"

Transcription

1 Guideline for Management of Primary Headache in Adults July 2012 This summary provides an evidence-based practical approach to assist primary health care providers in the diagnosis and management of adult patients with a long term history of headache. For more details, refer to Guideline for Primary Care Management of Headache in Adults Primary headache disorders are not due to another medical condition, and include primarily migraine and tension-type headache. Cluster headache, hemicrania continua, and new daily persistent headache are much rarer primary headache types and will not be discussed further in this summary. Secondary headache disorders are due to another medical disorder. Practice Point Rule out secondary headache when making a diagnosis of a primary headache disorder. Headache onset (thunderclap, association with head or neck trauma), headache progression, duration of attacks, and days per month with headache. Pain location (unilateral, bilateral, associated neck pain). Headache associated symptoms (nausea, vomiting, photophobia, phonophobia). Relationship of headache to possible precipitating factors (stress, posture, cough, exertion, straining, neck movements, jaw pain, etc.). Headache severity and effect of the headaches on work and family activities. Headache response and side effects to acute and preventive medications tried in the past. Presence of co-existent conditions that may influence treatment choice (insomnia, depression, anxiety, hypertension, asthma, and history of heart disease or stroke). 1 health care for specific clinical circumstances. They should be used as an adjunct to sound clinical decision making

2 Practice Points Neuroimaging is not indicated in patients with recurrent headache with the clinical features of migraine, a normal neurological examination, and no red flags. Neuroimaging, sinus x-rays, cervical spine x-rays, and EEG are not recommended for the routine assessment of the patient with headache. History and physical / neurological examination is usually sufficient to make a diagnosis of migraine or tension-type headache. Migraine: If patients have at least two of: 1) nausea during the attack; 2) light sensitivity during the attack; 3) some of the attacks interfere with their activities. Practice Points Migraine is by far the most common headache type in patients seeking help for headache from physicians. Migraine is historically under-diagnosed and under-treated. Many patients with migraine are not diagnosed with migraine when they consult a physician. Migraine should be considered in patients with recurrent moderate or severe headaches and a normal neurological examination. Patients consulting for bilateral headaches which interfere with their activities are likely to have migraine rather than tension-type headache and may require migraine specific medication. Consider a diagnosis of migraine in patients with a previous diagnosis of recurring sinus headache. Chronic migraine: If headache is present on 14 days a month or more, and headaches meet migraine diagnostic criteria or are quickly aborted by migraine specific medications (triptans or ergots) on 8 days a month or more. Consider whether medication overuse is present in all patients with chronic migraine (chronic migraine with medication overuse) 2

3 Practice Point Medication overuse is considered present when patients with migraine or tension-type headache use combination analgesics, opioids, or triptans on 10 or more days per month or acetaminophen or NSAIDs on 15 or more days a month. Episodic tension-type headache: If headache attacks are not associated with nausea, and have at least two of the following: 1) bilateral headache; 2) non-pulsating pain; 3) mild to moderate intensity; and 4) headache is not worsened by activity. Migraine management is complex and a comprehensive approach may be needed. All of the following should be considered. Training the patient in self-management: Self-management involves patients partnering with the health professional and taking an active role in management of their migraine. Patients may require some or all of the following skills. Self-monitoring to identify factors that influence their migraine. Managing migraine triggers effectively. Pacing activity to avoid triggering or exacerbating migraine. Maintaining a lifestyle that does not worsen migraine. Relaxation techniques. Maintaining good sleep hygiene. Stress management skills. Cognitive restructuring to avoid catastrophic/negative thinking. Communication skills to talk effectively about pain with family and others. Using acute and prophylactic medication appropriately. Headache diaries: Encourage patients to keep a headache diary to monitor headache frequency, intensity, triggering factors and medication use so that treatment can be adjusted as needed. Refer to Headache Diary Sheets. 3

4 Comprehensive migraine therapy includes management of lifestyle factors and triggers, acute and prophylactic medications, and migraine selfmanagement strategies. Acute pharmacological therapy: NSAIDs (including ASA), acetaminophen and triptans are the primary medications for acute migraine treatment. A triptan should be used when NSAIDs are not effective. Patients who do not respond well to one triptan may respond to another. Advise patients to take their medications early in their migraine attack, where possible, to improve effectiveness. For severe migraine attacks, consider providing an additional rescue medication if the patient s usual acute medication does not work consistently with every attack. Refer to medication tables in Guideline for Primary Care Management of Headache in Adults for drugs and dosages. Practice Points ASA, acetaminophen, NSAIDs, and triptans are the primary medications for acute migraine treatment. A triptan should be used when NSAIDs are not effective. Opioid containing analgesics are not recommended for routine use for migraine. Butalbital-containing combination analgesics should be avoided. Vast amounts of over-the-counter analgesics are taken for headache disorders and treatment is often sub-optimal. Prophylactic pharmacological therapy: Consider migraine pharmacological prophylaxis when: Recurrent migraine attacks are causing significant disability despite optimal acute drug therapy. The frequency of acute medication use is approaching levels that place the patient at risk for medication overuse headache. 4

5 When prescribing a prophylactic medication: 1. Educate patients on the need to take the medication daily and according to the prescribed frequency and dosage. 2. Ensure that patients have realistic expectations as to what the likely benefits will be; that is: a. Headache attacks will likely not be abolished completely. b. A reduction in headache frequency of 50% is usually considered worthwhile and successful. c. It may take 4 to 8 weeks for significant benefit to occur. d. If the prophylactic drug provides significant benefit in the first 2 months of therapy, this may increase further over several additional months of therapy. 3. Evaluate the effectiveness of therapy through the use of patient diaries that record headache frequency and drug use. 4. For most prophylactic drugs, initiate therapy with a low dose and increase the dosage gradually to minimize side effects. 5. Increase the dose until the drug proves effective, until dose-limiting side effects occur, or a target dose is reached. 6. Provide an adequate drug trial. Unless side effects mandate discontinuation, continue the prophylactic drug for at least 6 to 8 weeks after dose titration is completed. 7. Gradual discontinuation of the drug should be considered for many patients after 6 to 12 months of successful therapy, but preventive medications can be continued for much longer in some patients. The most commonly used prophylactic drugs are the beta-blockers, the tricyclic antidepressants, and topiramate, but many other drugs are also used, including divalproex sodium, candesartan, pizotifen, flunarizine, and others. OnabotulinumtoxinA is used for chronic migraine (migraine with headache on 15 days a month). Non-drug compounds which also have some prophylactic value include butterbur, riboflavin, magnesium citrate, and co-enzyme Q10. (Refer to medication tables in Guideline for Primary Care Management of Headache in Adults for more detail on drugs and dosages). Selective serotonin reuptake inhibitors are not recommended for migraine prophylaxis. 5

6 Practice Point A substantial number of people who might benefit from prophylactic therapy do not receive it. Non-pharmacological therapies: Recommended therapies include relaxation training, biofeedback, cognitive behavioural therapy, and acupuncture. Migraine Treatment in Pregnancy: Drugs for migraine should be avoided during pregnancy where possible. Acetaminophen 1000 mg and metoclopramide 10 mg can be used if necessary. If necessary, acetaminophen - codeine combination analgesics are an option. Ibuprofen 400 mg can be used but only during the second trimester of pregnancy. Sumatriptan should not be used routinely in pregnancy, but may be considered for use when other medications have failed and the benefits outweigh the risks. Preventive drugs should be gradually discontinued prior to the commencement of a planned pregnancy; or stopped as soon as possible during an unplanned pregnancy. Obtain specialist advice if it is necessary to continue migraine prophylaxis. Menstrual Migraine: Acute pharmacological treatment is similar to nonmenstrual migraine. For patients with refractory menstrual migraine, consider frovatriptan 2.5 mg twice a day starting 2 days before the anticipated onset of the menstrually associated migraine attack and continuing for a total of 6 days. 6

7 Careful monitoring of acute medication use by both the patient and the physician is important in the prevention of medication overuse headache. Headache diaries should be used by patients with frequent migraine to monitor acute medication use. When medication overuse headache is suspected, the patient should also be evaluated for: Psychiatric comorbidities (depression and anxiety); these may need to be considered in planning an overall treatment strategy. Psychological and physical drug dependence. Use of inappropriate coping strategies. Expanding the patient s repertoire of adaptive coping strategies may facilitate reduction of medication use and ultimate improvement in headache. Treatment plans for the patient with medication overuse headache should include: 1. Patient education with regard to medication overuse headache. Patients need to understand that: a. Acute medication overuse can increase headache frequency. b. When medication overuse is stopped, headache may worsen temporarily. c. Many patients will experience a long-term reduction in headache frequency after medication overuse is stopped. d. Prophylactic medications may become more effective. 2. Formulation of a plan for cessation of medication overuse. 3. A strategy for the treatment of remaining severe headache attacks with limitations on frequency of use (i.e. a triptan for patients with analgesic overuse, DHE for patients with triptan overuse, etc.). 4. Patient follow-up and support. 5. Pharmacological prophylaxis with the prophylactic medication started prior to or during medication withdrawal. 7

8 Stopping Medication Overuse: Withdrawal of the overused medication should be attempted in all patients with suspected medication overuse headache. Abrupt withdrawal should be advised for patients with suspected medication overuse headache caused by simple analgesics (acetaminophen, NSAIDs) or triptans, although gradual withdrawal is also an option. Gradual withdrawal should be advised for patients with suspected medication overuse headache caused by opioids and opioidcontaining analgesics. Practice Point Monitor for medication overuse Many patients with tension-type headache do not require medication. Reassurance, identification of trigger factors, adjusting lifestyle factors, and stress management are often helpful. Use Headache Diary Sheets for assessment and monitoring. Monitor for medication overuse. Acute Pharmacological Therapy: Recommended medications include: ibuprofen, aspirin, naproxen, diclofenac potassium, and acetaminophen. Pharmacological Prophylaxis: Consider prophylaxis if tension-type headaches are frequent. Efficacy of preventive medication is often limited and treatment may be hampered by side effects. Drug of first choice is amitriptyline. Non-pharmacological Therapy for Tension-type Headache: Recommended therapy includes: cognitive behaviour therapy, biofeedback, relaxation training, therapeutic exercise, and physical therapy. Primary headache disorders present many treatment challenges. Refer to Guideline for Primary Care Management of Headache in Adults for more management details. July

Tension-type headache Non-pharmacological and pharmacological treatment

Tension-type headache Non-pharmacological and pharmacological treatment Danish Headache Center Tension-type headache Non-pharmacological and pharmacological treatment Lars Bendtsen Associate professor, MD, PhD, Dr Med Sci Danish Headache Center, Department of Neurology Glostrup

More information

July 2012 Target Population. Adult patients 18 years or older in primary care settings.

July 2012 Target Population. Adult patients 18 years or older in primary care settings. Guideline for Primary Care Management of Headache in Adults July 2012 Target Population Adult patients 18 years or older in primary care settings. Exclusions: This guideline does not provide recommendations

More information

Tension-type headache Non-pharmacological and pharmacological treatment

Tension-type headache Non-pharmacological and pharmacological treatment Danish Headache Center Tension-type headache Non-pharmacological and pharmacological treatment Lars Bendtsen Associate professor, MD, PhD, Dr Med Sci Danish Headache Center, Department of Neurology Glostrup

More information

SIGN. Diagnosis and management of headache in adults. Quick Reference Guide. Scottish Intercollegiate Guidelines Network

SIGN. Diagnosis and management of headache in adults. Quick Reference Guide. Scottish Intercollegiate Guidelines Network SIGN Scottish Intercollegiate Guidelines Network 107 iagnosis and management of headache in adults Quick Reference Guide November 2008 opies of all SIGN guidelines are available online at www.sign.ac.uk

More information

HEADACHES IN CHILDREN AND ADOLESCENTS. Brian D. Ryals, M.D.

HEADACHES IN CHILDREN AND ADOLESCENTS. Brian D. Ryals, M.D. HEADACHES IN CHILDREN AND ADOLESCENTS Brian D. Ryals, M.D. Frequency and Type of Headaches in Schoolchildren 8993 children age 7-15 in Sweden Migraine in 4% Frequent Nonmigrainous in 7% Infrequent Nonmigrainous

More information

Headaches in Children How to Manage Difficult Headaches

Headaches in Children How to Manage Difficult Headaches Headaches in Children How to Manage Difficult Headaches Peter Procopis Childhood headaches Differential diagnosis Migraine Psychological Raised Pressure Childhood headaches Other causes: Constitutional

More information

When the Pain Won t Stop: Managing Chronic Daily Headache

When the Pain Won t Stop: Managing Chronic Daily Headache When the Pain Won t Stop: Managing Chronic Daily Headache Arnolda Eloff, MB, ChB, Mmed Presented at the University of Calgary s Wednesday Evening Course Program, Calgary, Alberta. Copyright Chronic daily

More information

None related to the presentation Grants to conduct clinical trials from:

None related to the presentation Grants to conduct clinical trials from: Chronic Daily Headache Bassel F. Shneker, MD, MBA Associate Professor Vice Chair, OSU Neurology The Ohio State University Wexner Medical Center Financial Disclosures None related to the presentation Grants

More information

Headaches and Kids. Jennifer Bickel, MD Assistant Professor of Neurology Co-Director of Headache Clinic Children s Mercy Hospital

Headaches and Kids. Jennifer Bickel, MD Assistant Professor of Neurology Co-Director of Headache Clinic Children s Mercy Hospital Headaches and Kids Jennifer Bickel, MD Assistant Professor of Neurology Co-Director of Headache Clinic Children s Mercy Hospital Overview Headache classifications and diagnosis Address common headache

More information

Welcome to the program!

Welcome to the program! Calgary Headache Assessment & Management Program (CHAMP) EDUCATION SESSION Welcome to the program! Why is this Session Mandatory? Provide headache management information and orientation to the Champ program

More information

Post Traumatic and other Headache Syndromes. Danielle L. Erb, MD Brain Rehabilitation Medicine, LLC Brain Injury Rehab Center, PRA

Post Traumatic and other Headache Syndromes. Danielle L. Erb, MD Brain Rehabilitation Medicine, LLC Brain Injury Rehab Center, PRA Post Traumatic and other Headache Syndromes Danielle L. Erb, MD Brain Rehabilitation Medicine, LLC Brain Injury Rehab Center, PRA Over 45 million Americans have chronic, recurring headaches 62% of these

More information

Headaches in Children

Headaches in Children Children s s Hospital Headaches in Children Manikum Moodley, MD, FRCP Section of Pediatric Neurology The Cleveland Clinic Foundation Introduction Headaches are common in children Most headaches are benign

More information

Sporadic attacks of severe tension-type headaches may respond to analgesics.

Sporadic attacks of severe tension-type headaches may respond to analgesics. MEDICATIONS While we are big advocates of non-drug treatments, many people do require the use of medications to control headaches. Headache medications are divided into two categories. Abortive drugs are

More information

HEADACHE. as. MUDr. Rudolf Černý, CSc. doc. MUDr. Petr Marusič, Ph.D.

HEADACHE. as. MUDr. Rudolf Černý, CSc. doc. MUDr. Petr Marusič, Ph.D. HEADACHE as. MUDr. Rudolf Černý, CSc. doc. MUDr. Petr Marusič, Ph.D. Dpt. of Neurology Charles University in Prague, 2nd Faculty of Medicine Motol University Hospital History of headache 1200 years B.C.

More information

Adult with headache. Problem-specific video guides to diagnosing patients and helping them with management and prevention

Adult with headache. Problem-specific video guides to diagnosing patients and helping them with management and prevention Adult with headache Problem-specific video guides to diagnosing patients and helping them with management and prevention London Strategic Clinical Networks London Neuroscience Strategic Clinical Network

More information

Emergency and inpatient treatment of migraine: An American Headache Society

Emergency and inpatient treatment of migraine: An American Headache Society Emergency and inpatient treatment of migraine: An American Headache Society survey. The objective of this study was to determine the practice preferences of AHS members for acute migraine treatment in

More information

What is chronic daily headache? Information for patients Neurology

What is chronic daily headache? Information for patients Neurology What is chronic daily headache? Information for patients Neurology What is chronic daily headache (CDH)? Chronic daily headache (CDH) is the term used when a person has a headache on 15 days a month or

More information

MIGRAINE. Denise Cambier M.D. Delaware Neurology, Ohio Health March 2013

MIGRAINE. Denise Cambier M.D. Delaware Neurology, Ohio Health March 2013 MIGRAINE Denise Cambier M.D. Delaware Neurology, Ohio Health March 2013 HISTORY: Graham and Wolff 1938: decreased amplitude of arterial pulsations coincided with reduction of headache with IV ergotamine.

More information

Headache. Primary Headache Disorders. The Pharmacist s Role in Assessment & Management. www.vhpharmsci.com

Headache. Primary Headache Disorders. The Pharmacist s Role in Assessment & Management. www.vhpharmsci.com Headache The Pharmacist s Role in Assessment & Peter Loewen, B.Sc.(Pharm), Pharm.D. Vancouver Hospital & Health Sciences Centre University of British Columbia ETC, Headache. Nan Quintin www.vhpharmsci.com

More information

Levels of evidence and grades of recommendation

Levels of evidence and grades of recommendation MOH Clinical Practice Guidelines 5/2007 Levels of evidence and grades of recommendation Levels of evidence Level Type of Evidence 1 + + High quality meta-analyses, systematic reviews of randomised controlled

More information

Guidance for Industry Migraine: Developing Drugs for Acute Treatment

Guidance for Industry Migraine: Developing Drugs for Acute Treatment Guidance for Industry Migraine: Developing Drugs for Acute Treatment DRAFT GUIDANCE This guidance document is being distributed for comment purposes only. Comments and suggestions regarding this draft

More information

HEADACHES IN CHILDREN : A CLINICAL APPROACH

HEADACHES IN CHILDREN : A CLINICAL APPROACH HEADACHES IN CHILDREN : A CLINICAL APPROACH Chong Shang Chee A physician is commonly faced with a child presenting with headaches. The assessment of a child s headache is challenging, but an accurate assessment

More information

Updated guidelines on headache management for use by the pharmacist

Updated guidelines on headache management for use by the pharmacist M I P C A MIGRAINE IN PRIMARY CARE ADVISORS Updated guidelines on headache management for use by the pharmacist Introduction N U M B E R 2 1, O C T O B E R 2 0 1 2 Headache is a major public health problem,

More information

Post-Concussive Headaches and Dizziness Louise M. Klebanoff, MD

Post-Concussive Headaches and Dizziness Louise M. Klebanoff, MD Post-Concussive Headaches and Dizziness Louise M. Klebanoff, MD Associate Professor and Vice Chairman for Operations Chief, General Neurology Department of Neurology Disclosures: None Introduction: Headaches

More information

Chronic daily headache

Chronic daily headache Chronic daily headache Chronic daily headache (CDH) is defined as any headache syndrome affecting more than half of the month, i.e. a headache on more than 15 days per month. It is also known as daily

More information

Classification of Chronic Headache

Classification of Chronic Headache Chronic Headache Classification of Chronic Headache JMAJ 47(3): 112 117, 2004 Mitsunori MORIMATSU Professor, Department of Neurology and Clinical Neuroscience, Yamaguchi University School of Medicine Abstract:

More information

Inside Treating tension-type headache

Inside Treating tension-type headache Headache and migraine Nearly everyone gets a headache occasionally, whereas about one in five women and one in fifteen men suffer from migraines. 1 Migraine treatment which works for one person often fails

More information

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population

More information

Medications for chronic pain

Medications for chronic pain Medications for chronic pain When it comes to treating chronic pain with medications, there are many to choose from. Different types of pain medications are used for different pain conditions. You may

More information

There are two different types of migraines: migraines without aura and migraines with aura.

There are two different types of migraines: migraines without aura and migraines with aura. What is migraine? A migraine is a relatively common medical condition that can severely affect the quality of life of the sufferer and his or her family and friends. 1 Almost 8% of Canadians over the age

More information

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN MANAGEMENT OF CHRONIC NON MALIGNANT PAIN Introduction The Manitoba Prescribing Practices Program (MPPP) recognizes the important role served by physicians in relieving pain and suffering and acknowledges

More information

Migraine and Related Headache Syndromes

Migraine and Related Headache Syndromes neurology Board Review Manual Statement of Editorial Purpose The Hospital Physician Neurology Board Review Manual is a peer-reviewed study guide for residents and practicing physicians preparing for board

More information

9/2/2010. Debbie Zajac has no conflict of interest to disclose.

9/2/2010. Debbie Zajac has no conflict of interest to disclose. Management of Chronic Headaches: An Interdisciplinary Approach September 25, 2010 Deborah C. Zajac RN-BC Clinical Coordinator / IMATCH Program Debbie Zajac has no conflict of interest to disclose. Identify

More information

The Pediatric Headache Handbook

The Pediatric Headache Handbook The Pediatric Headache Handbook For the Primary Care Physician Brought to you by the Division of Child Neurology Classification of headache patterns in children Acute onset of worst headache of my life

More information

Women and Migraine: The Hormonal Link

Women and Migraine: The Hormonal Link Women and Migraine: The Hormonal Link March 1, 2012 Norma Jo Waxman, M.D. Associate Professor of Family and Community Medicine Bixby Center for Global Reproductive Health University of California San Francisco

More information

New appendix criteria open for a broader concept of chronic migraine

New appendix criteria open for a broader concept of chronic migraine Blackwell Publishing LtdOxford, UKCHACephalalgia0333-1024Blackwell Science, 20062006266742746Original ArticleA broader concept of chronic migrainej Olesen et al. BRIEF REPORT New appendix criteria open

More information

Prednisone for the treatment of withdrawal headache in patients with medication overuse headache: A randomized, double-blind, placebo-controlled study

Prednisone for the treatment of withdrawal headache in patients with medication overuse headache: A randomized, double-blind, placebo-controlled study Brief Report Prednisone for the treatment of withdrawal headache in patients with medication overuse headache: A randomized, double-blind, placebo-controlled study Cephalalgia 33(3) 202 207! International

More information

One Day at a Time: When Headaches Become Chronic. Robert Shapiro, MD, PhD

One Day at a Time: When Headaches Become Chronic. Robert Shapiro, MD, PhD One Day at a Time: When Headaches Become Chronic Robert Shapiro, MD, PhD Disclosures Scientific/Medical Advisory Boards (since 10/12) Transcept Pharmaceuticals Chronic Headaches: Overview What is a chronic

More information

A chiropractic approach to managing migraine

A chiropractic approach to managing migraine A chiropractic approach to managing migraine What is chiropractic? Chiropractic is a primary healthcare profession that specialises in the diagnosis, treatment and overall management of conditions that

More information

BOTOX Treatment. for Chronic Migraine. Information for patients and their families. Botulinum Toxin Type A

BOTOX Treatment. for Chronic Migraine. Information for patients and their families. Botulinum Toxin Type A BOTOX Treatment Botulinum Toxin Type A for Chronic Migraine Information for patients and their families. Is Chronic Migraine the same as Migraine? Chronic Migraine is similar to migraine as sufferers experience

More information

Frequent headache is defined as headaches 15 days/month and daily. Course of Frequent/Daily Headache in the General Population and in Medical Practice

Frequent headache is defined as headaches 15 days/month and daily. Course of Frequent/Daily Headache in the General Population and in Medical Practice DISEASE STATE REVIEW Course of Frequent/Daily Headache in the General Population and in Medical Practice Egilius L.H. Spierings, MD, PhD, Willem K.P. Mutsaerts, MSc Department of Neurology, Brigham and

More information

i n p r i m a r y c a r e *

i n p r i m a r y c a r e * Headache i n p r i m a r y c a r e * Key Advisers: Dr Neil Whittaker GP, Nelson Dr Alistair Dunn GP, Whangarei Expert Reviewer: Dr Alan Wright Neurologist, Dunedin Every headache presentation is unique

More information

PROTOCOL SYNOPSIS Evaluation of long-term opioid efficacy for chronic pain

PROTOCOL SYNOPSIS Evaluation of long-term opioid efficacy for chronic pain P a g e 1 PROTOCOL SYNOPSIS Evaluation of long-term opioid efficacy for chronic pain Clinical Phase 4 Study Centers Study Period 25 U.S. sites identified and reviewed by the Steering Committee and Contract

More information

Post-traumatic stress disorder overview

Post-traumatic stress disorder overview Post-traumatic stress disorder overview A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive

More information

POST-TRAUMATIC STRESS DISORDER PTSD Diagnostic Criteria PTSD Detection and Diagnosis PC-PTSD Screen PCL-C Screen PTSD Treatment Treatment Algorithm

POST-TRAUMATIC STRESS DISORDER PTSD Diagnostic Criteria PTSD Detection and Diagnosis PC-PTSD Screen PCL-C Screen PTSD Treatment Treatment Algorithm E-Resource March, 2014 POST-TRAUMATIC STRESS DISORDER PTSD Diagnostic Criteria PTSD Detection and Diagnosis PC-PTSD Screen PCL-C Screen PTSD Treatment Treatment Algorithm Post-traumatic Stress Disorder

More information

What kind of headache do you have?

What kind of headache do you have? What kind of headache do you have? Less than 2% of the population have never had a headache. Most of us get them from time to time and they are usually resolved with a couple of painkillers, a rest or

More information

Kids get headaches too! Evaluation and treatment of the pediatric headache

Kids get headaches too! Evaluation and treatment of the pediatric headache 3:45 4:25pm Approach to the Child with Headaches SPEAKER Jason T. Lerner, MD Presenter Disclosure Information The following relationships exist related to this presentation: Jason T. Lerner, MD: No financial

More information

MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION

MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION Executive summary of recommendations Details of recommendations can be found in the main text at the pages indicated. Clinical evaluation D The basic

More information

Awide choice of pharmacotherapies is

Awide choice of pharmacotherapies is NONPHARMACOLOGIC PREVENTION AND TREATMENT OF RECURRENT HEADACHE * Donald B. Penzien, PhD, Mary G. Gabb, MS ABSTRACT Nonpharmacologic therapies play an important role in the prevention and treatment of

More information

Depression in Older Persons

Depression in Older Persons Depression in Older Persons How common is depression in later life? Depression affects more than 6.5 million of the 35 million Americans aged 65 or older. Most people in this stage of life with depression

More information

Step 4: Complex and severe depression in adults

Step 4: Complex and severe depression in adults Step 4: Complex and severe depression in adults A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive

More information

HEADACHE UK An alliance working for people with headache. School Policy Guidelines for School Students with Migraine and Troublesome Headache

HEADACHE UK An alliance working for people with headache. School Policy Guidelines for School Students with Migraine and Troublesome Headache HEADACHE UK An alliance working for people with headache School Policy Guidelines for School Students with Migraine and Troublesome Headache Content Background 2 Aim The extent and impact of the problem

More information

33 % of whiplash patients develop. headaches originating from the upper. cervical spine

33 % of whiplash patients develop. headaches originating from the upper. cervical spine 33 % of whiplash patients develop headaches originating from the upper cervical spine - Dr Nikolai Bogduk Spine, 1995 1 Physical Treatments for Headache: A Structured Review Headache: The Journal of Head

More information

4.1 How can migraine treatments be assessed and rated? 86 STRATEGIES FOR USING MIGRAINE THERAPIES

4.1 How can migraine treatments be assessed and rated? 86 STRATEGIES FOR USING MIGRAINE THERAPIES Migraine treatments 4 4.1 How can migraine treatments be assessed and rated? 86 STRATEGIES FOR USING MIGRAINE THERAPIES 4.2 What are the strategies for treating migraine? 86 4.3 How should behavioural

More information

UBC Pain Medicine Residency Program: CanMEDS Goals and Objectives of the UBC Headache Clinic Rotation

UBC Pain Medicine Residency Program: CanMEDS Goals and Objectives of the UBC Headache Clinic Rotation UBC Pain Medicine Residency Program: CanMEDS Goals and Objectives of the UBC Headache Clinic Rotation Overview: The UBC Headache Clinic is located in located in rm. 267, on the 2nd floor of UBC Hospital.

More information

Evidence-Based Guidelines for Migraine Headache in the Primary Care Setting: Pharmacological Management of Acute Attacks

Evidence-Based Guidelines for Migraine Headache in the Primary Care Setting: Pharmacological Management of Acute Attacks Evidence-Based Guidelines for Migraine Headache in the Primary Care Setting: Pharmacological Management of Acute Attacks David B. Matchar, MD Professor of Medicine and Director, Center for Clinical Health

More information

Treating Severe Migraine Headaches in the Emergency Room A Review of the Research for Adults

Treating Severe Migraine Headaches in the Emergency Room A Review of the Research for Adults Treating Severe Migraine Headaches in the Emergency Room A Review of the Research for Adults Is This Information Right for Me? Yes, this information is right for you if: Your doctor* has told you that

More information

Web: www.migraine.org.uk. Medication overuse headache and undergoing a detox programme

Web: www.migraine.org.uk. Medication overuse headache and undergoing a detox programme Web: www.migraine.org.uk Medication overuse headache and undergoing a detox programme Web: www.migraine.org.uk/moh What is medication overuse headache? Medication taken to help relieve migraine attacks

More information

European principles of management of common headache disorders in primary care. Scope and Purpose

European principles of management of common headache disorders in primary care. Scope and Purpose in conjunction with Lifting The Burden The Global Campaign against Headache A collaboration between the World Health Organization, non-governmental organisations, academic institutions and individuals

More information

Abstral Prescriber and Pharmacist Guide

Abstral Prescriber and Pharmacist Guide Abstral Prescriber and Pharmacist Guide fentanyl citrate sublingual tablets Introduction The Abstral Prescriber and Pharmacist Guide is designed to support healthcare professionals in the diagnosis of

More information

Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache

Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache Douglas C. McCrory, MD, MHSc Donald B. Penzien, PhD Vic Hasselblad, PhD Rebecca N. Gray, DPhil Duke University

More information

TREATING MAJOR DEPRESSIVE DISORDER

TREATING MAJOR DEPRESSIVE DISORDER TREATING MAJOR DEPRESSIVE DISORDER A Quick Reference Guide Based on Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Second Edition, originally published in April 2000.

More information

The Mainz Pain Staging System (MPSS) Instructions for use of the MPSS-Scoring Form

The Mainz Pain Staging System (MPSS) Instructions for use of the MPSS-Scoring Form The Mainz Pain Staging System (MPSS) Instructions for use of the MPSS-Scoring Form H.U. Gerbershagen, J. Korb, B. Nagel, P. Nilges, German Red Cross Pain Center Mainz, FRG 1.1. Axis I: Temporal Aspects

More information

Algorithm for Initiating Antidepressant Therapy in Depression

Algorithm for Initiating Antidepressant Therapy in Depression Algorithm for Initiating Antidepressant Therapy in Depression Refer for psychotherapy if patient preference or add cognitive behavioural office skills to antidepressant medication Moderate to Severe depression

More information

Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain

Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain Section I: Preamble The Michigan Boards of Medicine and Osteopathic Medicine & Surgery recognize that principles of quality

More information

Proper Diagnosis and Treatment for the Headache Patient Alexander Feoktistov MD, PhD

Proper Diagnosis and Treatment for the Headache Patient Alexander Feoktistov MD, PhD Proper Diagnosis and Treatment for the Headache Patient Alexander Feoktistov MD, PhD Director of Clinical Research Diamond Headache Clinic Chicago, IL 2014 Objectives Get familiar with primary headache

More information

Review of Pharmacological Pain Management

Review of Pharmacological Pain Management Review of Pharmacological Pain Management CHAMP Activities are possible with generous support from The Atlantic Philanthropies and The John A. Hartford Foundation The WHO Pain Ladder The World Health Organization

More information

Headaches when to worry is a scan always needed? Regan Solomons

Headaches when to worry is a scan always needed? Regan Solomons Headaches when to worry is a scan always needed? Regan Solomons Introduction o Headache is a common problem in childhood o Up to 25% of school children suffer from chronic recurrent headaches o Primary

More information

BENZODIAZEPINE CONSIDERATIONS IN WORKERS COMPENSATION: IMPLICATIONS FOR WORK DISABILITY AND CLAIM COSTS By: Michael Erdil MD, FACOEM

BENZODIAZEPINE CONSIDERATIONS IN WORKERS COMPENSATION: IMPLICATIONS FOR WORK DISABILITY AND CLAIM COSTS By: Michael Erdil MD, FACOEM 3 rd Quarter 2015 BENZODIAZEPINE CONSIDERATIONS IN WORKERS COMPENSATION: IMPLICATIONS FOR WORK DISABILITY AND CLAIM COSTS By: Michael Erdil MD, FACOEM Introduction Benzodiazepines, sometimes called "benzos",

More information

Naltrexone And Alcoholism Treatment Treatment Improvement Protocol (TIP) Series 28

Naltrexone And Alcoholism Treatment Treatment Improvement Protocol (TIP) Series 28 Naltrexone And Alcoholism Treatment Treatment Improvement Protocol (TIP) Series 28 Executive Summary and Recommendations Psychosocial treatments for alcoholism have been shown to increase abstinence rates

More information

GUIDELINES FOR USE OF PSYCHOTHERAPEUTIC MEDICATIONS IN OLDER ADULTS

GUIDELINES FOR USE OF PSYCHOTHERAPEUTIC MEDICATIONS IN OLDER ADULTS GUIDELINES GUIDELINES FOR USE OF PSYCHOTHERAPEUTIC MEDICATIONS IN OLDER ADULTS Preamble The American Society of Consultant Pharmacists has developed these guidelines for use of psychotherapeutic medications

More information

Guideline for primary care management of headache in adults

Guideline for primary care management of headache in adults Clinical Review Guideline for primary care management of headache in adults Werner J. Becker MD FRCP(C) Ted Findlay DO CCFP Carmen Moga MD MSc N. Ann Scott PhD Christa Harstall MHSA Paul Taenzer PhD RPsych

More information

Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance

Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Introduction Indication/Licensing information: Naltrexone is licensed for use as an additional therapy, within

More information

FEDERAL BUREAU OF PRISONS CLINICAL PRACTICE GUIDELINES FOR THE MANAGEMENT OF HEADACHE September 2003

FEDERAL BUREAU OF PRISONS CLINICAL PRACTICE GUIDELINES FOR THE MANAGEMENT OF HEADACHE September 2003 FEDERAL BUREAU OF PRISONS CLINICAL PRACTICE GUIDELINES FOR THE MANAGEMENT OF HEADACHE September 2003 PURPOSE The Federal Bureau of Prisons Clinical Practice Guidelines for the Management of Headache provide

More information

Depression in adults with a chronic physical health problem

Depression in adults with a chronic physical health problem Depression in adults with a chronic physical health problem Treatment and management Issued: October 2009 NICE clinical guideline 91 guidance.nice.org.uk/cg91 NICE has accredited the process used by the

More information

in young people Management of depression in primary care Key recommendations: 1 Management

in young people Management of depression in primary care Key recommendations: 1 Management Management of depression in young people in primary care Key recommendations: 1 Management A young person with mild or moderate depression should typically be managed within primary care services A strength-based

More information

Naltrexone and Alcoholism Treatment Test

Naltrexone and Alcoholism Treatment Test Naltrexone and Alcoholism Treatment Test Following your reading of the course material found in TIP No. 28. Please read the following statements and indicate the correct answer on the answer sheet. A score

More information

THE COMMONWEALTH OF MASSACHUSETTS Department of Industrial Accidents

THE COMMONWEALTH OF MASSACHUSETTS Department of Industrial Accidents THE COMMONWEALTH OF MASSACHUSETTS Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, Massachusetts 02114-2017 DEVAL L. PATRICK Governor PHILIP L. HILLMAN Director TIMOTHY P. MURRAY

More information

Headaches. Myriam Camilleri. Summary. Differential Diagnosis. Introduction. Achieving the diagnosis. Incidence. Keywords.

Headaches. Myriam Camilleri. Summary. Differential Diagnosis. Introduction. Achieving the diagnosis. Incidence. Keywords. In Practice Headaches Myriam Camilleri Summary A 30 year old lady was seen by her family doctor during a busy clinic complaining of three episodes of left-sided headache over the previous four months.

More information

HAWAII BOARD OF MEDICAL EXAMINERS PAIN MANAGEMENT GUIDELINES

HAWAII BOARD OF MEDICAL EXAMINERS PAIN MANAGEMENT GUIDELINES Pursuant to section 453-1.5, Hawaii Revised Statutes, the Board of Medical Examiners ("Board") has established guidelines for physicians with respect to the care and treatment of patients with severe acute

More information

Kids Get Headaches Too

Kids Get Headaches Too health information Kids Get Headaches Too Alberta Health Services It is hard to see your child in pain. It can be frustrating or scary for a child to have headaches. In this booklet you will learn about:

More information

Authors and Disclosures

Authors and Disclosures Authors and Disclosures www.medscape.com Marco Trucco, MD, Piero Meineri, MD, Luigi Ruiz, MD, Maurizio Gionco, MD, on behalf of the "Gruppo Neurologico Ospedaliero Interregionale per lo Studio delle Cefalee"

More information

Management of chronic headache

Management of chronic headache Neurology Roy Beran Management of chronic headache Background Headache remains the most common cause of neurological consultation in clinical practice for which correct diagnosis and treatment are essential.

More information

Review for NHS Surrey Prescribing Clinical Network. Treatment: Botox for chronic migraine. Prepared by: Victoria Overland

Review for NHS Surrey Prescribing Clinical Network. Treatment: Botox for chronic migraine. Prepared by: Victoria Overland Review for NHS Surrey Prescribing Clinical Network Treatment: Botox for chronic migraine Prepared by: Victoria Overland Date: To be considered at September 2012 PCN meeting 1. Purpose of the Review NICE

More information

MUSC Patient Handout Patient and Family Education About Migraine Headaches

MUSC Patient Handout Patient and Family Education About Migraine Headaches MUSC Patient Handout Patient and Family Education About Migraine Headaches Changing What s Possible in Health Care. As an academic medical center, MUSC offers benefits to the residents of South Carolina

More information

Views and Perspectives

Views and Perspectives Headache 2010 American Headache Society ISSN 0017-8748 doi: 10.1111/j.1526-4610.2010.01764.x Published by Wiley Periodicals, Inc. Views and Perspectives Defining the Pharmacologically Intractable Headache

More information

For a full list of MS Trust publications, to sign up for Open Door and much more visit our website at www.mstrust.org.uk

For a full list of MS Trust publications, to sign up for Open Door and much more visit our website at www.mstrust.org.uk Depression We hope you find the information in this factsheet helpful. If you would like to speak with someone about any aspect of MS, contact the MS Trust information team and they will help find answers

More information

Helping the Child and Adolescent with Headaches: School Absences, Social Concerns, Parents

Helping the Child and Adolescent with Headaches: School Absences, Social Concerns, Parents Helping the Child and Adolescent with Headaches: School Absences, Social Concerns, Parents Randall Weeks, Ph.D. New England Institute for Behavioral Medicine Stamford, CT HCNE--- ---Stowe, VT 2009 OUTLINE

More information

Chronic migraine and medication overuse headache: clarifying the current International Headache Society classification criteria

Chronic migraine and medication overuse headache: clarifying the current International Headache Society classification criteria Chronic migraine and medication overuse headache: clarifying the current International Headache Society classification criteria doi:10.1111/j.1468-2982.2008.01753.x C Sun-Edelstein 1, ME Bigal 2 & AM Rapoport

More information

Ultram (tramadol), Ultram ER (tramadol extended-release tablets); Conzip (tramadol extended-release capsules), Ultracet (tramadol / acetaminophen)

Ultram (tramadol), Ultram ER (tramadol extended-release tablets); Conzip (tramadol extended-release capsules), Ultracet (tramadol / acetaminophen) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.02.35 Subject: Tramadol Acetaminophen Page: 1 of 8 Last Review Date: September 18, 2015 Tramadol Acetaminophen

More information

Why are antidepressants used to treat IBS? Some medicines can have more than one action (benefit) in treating medical problems.

Why are antidepressants used to treat IBS? Some medicines can have more than one action (benefit) in treating medical problems. The Use of Antidepressants in the Treatment of Irritable Bowel Syndrome and Other Functional GI Disorders Christine B. Dalton, PA-C Douglas A. Drossman, MD What are functional GI disorders? There are more

More information

IMR ISSUES, DECISIONS AND RATIONALES The Final Determination was based on decisions for the disputed items/services set forth below:

IMR ISSUES, DECISIONS AND RATIONALES The Final Determination was based on decisions for the disputed items/services set forth below: Case Number: CM13-0018009 Date Assigned: 10/11/2013 Date of Injury: 06/11/2004 Decision Date: 01/13/2014 UR Denial Date: 08/16/2013 Priority: Standard Application Received: 08/29/2013 HOW THE IMR FINAL

More information

Antidepressant Skills @ Work Dealing with Mood Problems in the Workplace

Antidepressant Skills @ Work Dealing with Mood Problems in the Workplace Antidepressant Skills @ Work Dealing with Mood Problems in the Workplace Dr. Joti Samra PhD, R.Psych. Adjunct Professor & Research Scientist CARMHA www.carmha.ca Dr. Merv Gilbert PhD, R.Psych. Principal

More information

MIGRAINE: QUESTIONS AND ANSWERS FOR PATIENTS Headache Research and Treatment Program Department of Neurology, David Geffen School of Medicine at UCLA

MIGRAINE: QUESTIONS AND ANSWERS FOR PATIENTS Headache Research and Treatment Program Department of Neurology, David Geffen School of Medicine at UCLA MIGRAINE: QUESTIONS AND ANSWERS FOR PATIENTS Headache Research and Treatment Program Department of Neurology, David Geffen School of Medicine at UCLA What is a migraine? Migraine is not just a headache,

More information

Conjoint Professor Brian Draper

Conjoint Professor Brian Draper Chronic Serious Mental Illness and Dementia Optimising Quality Care Psychiatry Conjoint Professor Brian Draper Academic Dept. for Old Age Psychiatry, Prince of Wales Hospital, Randwick Cognitive Course

More information

TITLE: Cannabinoids for the Treatment of Post-Traumatic Stress Disorder: A Review of the Clinical Effectiveness and Guidelines

TITLE: Cannabinoids for the Treatment of Post-Traumatic Stress Disorder: A Review of the Clinical Effectiveness and Guidelines TITLE: Cannabinoids for the Treatment of Post-Traumatic Stress Disorder: A Review of the Clinical Effectiveness and Guidelines DATE: 01 December 2009 CONTEXT AND POLICY ISSUES: Post-traumatic stress disorder

More information

Chronic daily headache with analgesic overuse Epidemiology and impact on quality of life. NEUROLOGY April, 2004;62:1338 1342

Chronic daily headache with analgesic overuse Epidemiology and impact on quality of life. NEUROLOGY April, 2004;62:1338 1342 Chronic daily headache with analgesic overuse Epidemiology and impact on quality of life 1 NEUROLOGY April, 2004;62:1338 1342 R. Colás, MD; P. Muñoz, MD; R. Temprano, MD; C. Gómez, SW; and J. Pascual,

More information

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Section I: Preamble The New Hampshire Medical Society believes that principles

More information

Borderline personality disorder

Borderline personality disorder Borderline personality disorder Treatment and management Issued: January 2009 NICE clinical guideline 78 guidance.nice.org.uk/cg78 NICE 2009 Contents Introduction... 3 Person-centred care... 5 Key priorities

More information

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,

More information