Dowson A J, Sender J, Lipscombe S, Cady R K, Tepper S J, Smith R, Smith T R, Taylor F R, Boudreau G P, van Duijn N P, Poole A C, Baos V, Wöber C
King's Headache Service, King's College Hospital, London, UK.
Int J Clin Pract. 2003 Jul-Aug;57(6):493-507.
Published guidelines for the management of migraine in primary care were evaluated by an international advisory board of headache specialists, to establish evidence-based principles of migraine management that could be recommended for international use. Twelve principles of migraine management were identified, covering screening, diagnosis, management and treatments: Almost all headaches are benign/primary and can be managed by all practising clinicians. Use questions/a questionnaire to assess the impact on daily living and everyday activities, for diagnostic screening and to aid management decisions. Share migraine management between the clinician and the patient. Provide individualised care for migraine and encourage patients to manage their migraine. Follow up patients, preferably with migraine calendars or diaries. Regularly re-evaluate the success of therapy using specific outcome measures and monitor the use of acute and prophylactic medications regularly. Adapt migraine management to changes that occur in the illness and its presentation over the years. Provide acute medication to all migraine patients and recommend it is taken at the appropriate time, during the attack. Provide rescue medication/symptomatic treatment for when the initial therapy fails. Offer to prescribe prophylactic medications, as well as lifestyle changes, to patients who have four or more migraine attacks per month or who are resistant to acute medications. Consider concurrent co-morbidities in the choice of appropriate prophylactic medication. Work with the patient to achieve comfort with mutually agreed upon treatment and ensure that it is practical for their lifestyle and headache presentation. Using these principles, practising clinicians can screen and diagnose their headache patients effectively and manage their migraine patients over the long-term natural history of the migraine process. In this way, the majority of migraine patients can be well treated in primary care, ensuring a structured and individualised approach to headache management, and conserving valuable healthcare resources.
头痛专家国际咨询委员会对已发布的基层医疗中偏头痛管理指南进行了评估，以确立可推荐用于国际的基于证据的偏头痛管理原则。确定了十二条偏头痛管理原则，涵盖筛查、诊断、管理和治疗：几乎所有头痛都是良性/原发性的，所有执业临床医生均可进行管理。使用问题/问卷来评估对日常生活和日常活动的影响，用于诊断筛查并辅助管理决策。临床医生和患者共同进行偏头痛管理。为偏头痛患者提供个性化护理，并鼓励患者管理自己的偏头痛。对患者进行随访，最好使用偏头痛日历或日记。定期使用特定的结局指标重新评估治疗的成功率，并定期监测急性和预防性药物的使用情况。根据多年来疾病及其表现发生的变化调整偏头痛管理。为所有偏头痛患者提供急性药物，并建议在发作期间的适当时间服用。当初始治疗失败时，提供急救药物/对症治疗。为每月有四次或更多次偏头痛发作或对急性药物耐药的患者开预防性药物以及建议改变生活方式。在选择合适的预防性药物时考虑并存的合并症。与患者合作，以实现对双方商定的治疗的接受度，并确保其对患者的生活方式和头痛表现切实可行。运用这些原则，执业临床医生可以有效地筛查和诊断头痛患者，并在偏头痛病程的长期自然史中管理偏头痛患者。通过这种方式，大多数偏头痛患者可以在基层医疗中得到良好治疗，确保采用结构化和个性化的头痛管理方法，并节省宝贵的医疗资源。
