Nation's two largest medical specialty groups issue migraine treatment guidelines

November 18, 2002

PHILADELPHIA -- (November 19, 2002) Migraine headaches can be successfully treated and in many cases prevented, say new joint clinical guidelines from the nation's two largest groups of primary care physicians. The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) and the American Academy of Family Physicians (AAFP) say the first line of treatment for migraines are non-steroidal, anti-inflammatory drugs (NSAIDs), followed by prescription drugs called triptans and DHE nasal spray for more severe headaches. The guidelines are published in the Nov. 19, 2002, issue of Annals of Internal Medicine.

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 at 5 p.m., EST, Monday, Nov. 18.


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 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

American College of Physicians

Related Migraines Articles from Brightsurf:

TMS shows promise in treating stroke, dementia and migraines
TMS shows promise in treating a broad range of neurological disorders, including stroke, dementia and migraines.

Nightly sleep disturbance linked to daily risk of migraines
The team's findings generally support patients' reports of sleep disturbance as a trigger for migraines.

A new link between migraines, opioid overuse may be key to treating pain
Researchers have discovered that a peptide links together migraine pain and pain induced by opioid overuse.

Migraines linked to higher risk of dementia
Dementia is the most common neurological disease in older adults, whereas headaches, including migraines, are the most common neurological disorder across all ages.

1-2 caffeinated drinks not linked with higher risk of migraines; 3+ may trigger them
In a study published in the American Journal of Medicine, researchers at Beth Israel Deaconess Medical Center (BIDMC), Brigham and Women's Hospital and the Harvard T.H.

New antibody treatment provides little relief for high-frequency migraine patients
An early assessment reveals that the newly approved antibody treatment Erenumbab does not seem effective among patients who suffer from high-frequency migraines.

Migraine increases the risk of complications during pregnancy and childbirth
Pregnant women with migraine have an increased risk of miscarriage, caesarean sections and giving birth to a child with low birth weight.

Migraines may increase risk of pregnancy complications
In a study of women in Denmark with and without migraines who became pregnant, migraines were associated with an increased risk of pregnancy-associated hypertension disorders in the mother.

One in every 12 Canadian with migraines has attempted suicide
A new study by the University of Toronto, published online this week in the journal Archives of Suicide Research, found that adults with migraine who had been sexually abused during childhood were three times more likely to have attempted suicide.

Discovery of novel mechanisms that cause migraines
Researchers at CNRS, Université Côte d'Azur and Inserm have demonstrated a new mechanism related to the onset of migraine.

Read More: Migraines News and Migraines Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to