Migraines are severe recurring headaches that can disable sufferers for hours up to several days. In addition to throbbing head pain, symptoms can include nausea, vomiting, and sensitivity to light, noise and odors.
The first line NSAIDs proven to work are the familiar, inexpensive, over-the-counter, medications aspirin and ibuprofen as well as naproxen sodium and a combination of acetaminophen plus aspirin and caffeine. Acetaminophen alone has been proven not to work for migraines.
If NSAIDs don't work, physicians should prescribe drugs called triptans. The guidelines advise treating migraines immediately and also treating the nausea and vomiting that accompany some migraines with specific remedies for these symptoms. The recommended medications were deemed effective in at least two double-blind, placebo-controlled trials.
"Migraine patients should know that migraines can and should be treated at once," said Kevin B. Weiss, MD, chairman of the ACP-ASIM Clinical Efficacy Assessment Subcommittee that helped develop the guidelines. "We physicians don't want patients suffering longer than needed. We want to help them get on their feet and functioning."
"Another goal is to reduce use of back-up and rescue medications," Weiss said. "Patients should know that more isn't necessarily better when treating migraines. And medication overuse can actually lead to more headaches, sometimes called rebound headaches."
"Headaches are the seventh leading reason patients in the United States visit their physician," said Eric M. Wall, MD, MPH, the AAFP representative for guideline development. "It is important that physicians know the evidence supporting migraine headache treatments that are currently available and discuss treatment options with patients who have migraine headaches."
The guidelines point out that the most successful treatment results from the patient's active involvement in charting the migraines and identifying and avoiding headache triggers. Commonly reported triggers include alcohol, chocolate, caffeine, red wine, foods containing additives (such as monosodium glutamate, tyramine or nitrates), sleep loss, stress, skipped meals, weather changes, perfumes or fumes.
About 28 million people in the United States suffer from migraines, or 18 percent of all women and 6.5 percent of all men. Migraines are said to be a significant cause of employee absences and lowered productivity.
Migraines can sometimes be prevented or attacks made less frequent. Likely candidates for preventive therapy are patients who have two or more attacks a month producing disability lasting three or more days per month and/or who have tried many NSAIDs, triptans and other medications unsuccessfully.
Preventive therapy can include drugs such as beta-blockers, antidepressants, anticonvulsants or NSAIDs. The guidelines outline the strengths and side effects of specific drugs and caution that although many drugs are available, only a few have proven effective in preventing or mitigating migraines. In general, prevention begins with the lowest effective dose. The goal is to give each treatment an adequate trial, avoid interfering medications and create a formal management plan with the patient.
The guidelines note that migraines or other headaches are not symptoms of brain tumors, but patients with neurological symptoms such as tingling, and facial weakness or drooping should tell their internist or family physician. The guidelines are posted on http://www.annals.org at 5 p.m., EST, Monday, Nov. 18.
NOTES TO EDITOR:
Embargoed copies of the guidelines can be obtained by calling the ACP-ASIM Communications Department at 800-523-1546, Ext. 2656.
To contact Dr. Eric Wall, please call Tasha Stephens in the AAFP Public Relations Dept., 913-906-6253 or 800-274-2237, Ext. 5224.
To contact Dr. Kevin Weiss, director, Midwest Center for Health Services Research and Policy, Hines VA Hospital, Hines, Ill., please call Susan Anderson in the ACP-ASIM communications department at (215) 351-2653 or (800) 523-1546, ext. 2653. Dr. Weiss is also the chair of the ACP-ASIM Clinical Efficacy Assessment Subcommittee and was a member of the group that wrote the migraine guidelines.
This study is highlighted in the Internal Medicine Report video news release (VNR) series, produced by the American College of Physicians-American Society of Internal Medicine. The VNR will be released on Monday, Nov. 18, 2002, at 5 p.m. EST on the coordinates below.
Downlink time:
9:00 AM - 9:30 AM, EDT, Telstar 6, Transponder 11 C-Band (HOLD), Downlink Freq: 3920 (V)
2:00 PM - 2:30 PM, EDT, Telstar 6, Transponder 11 C-Band (HOLD), Downlink Freq: 3920 (V)
More information on migraines see http://www.doctorsforadults.com. The Doctors for Adults Web site is a public service developed by the American College of Physicians-American Society of Internal Medicine.
Founded in 1947, the American Academy of Family Physicians represents more than 93,500 physicians and medical students nationwide. It is the only medical specialty organization devoted solely to primary care.
Founded in 1915, the American College of Physicians, now the American College of Physicians-American Society of Internal Medicine, represents more than 115,000 doctors of internal medicine and medical students. Internists are specialists in the prevention, detection, and treatment of illnesses that primarily affect adults.
CONTACT: Tasha Stephens, AAFP Public Relations Dept., 800-274-2237, Ext. 5224 Susan Anderson, ACP-ASIM Communications Dept., 215-351-2653
Journal
Annals of Internal Medicine