Lewis Headache Clinic, Department of Neurology, Barrow Neurological Institute, Dignity Health, Phoenix, Arizona, USA.
Alberta Health Services, Alberta's Children Hospital, Calgary, Alberta, Canada.
Headache. 2024 Jul-Aug;64(7):869-872. doi: 10.1111/head.14744. Epub 2024 Jun 3.
The primary objective of this proposed guideline is to update the prior 2016 guideline on parenteral pharmacotherapies for the management of adults with a migraine attack in the emergency department (ED).
We will conduct an updated systematic review and meta-analysis using the 2016 guideline methodology to provide clinical recommendations. The same search strategy will be used for studies up to 2023, with a new search strategy added to capture studies of nerve blocks and sphenopalatine blocks. Medline, Embase, Cochrane, clinicaltrials.gov, and the World Health Organization International Clinical Trial Registry Platform will be searched. Our inclusion criteria consist of studies involving adults with a diagnosis of migraine, utilizing medications administered intravenously, intramuscularly, or subcutaneously in a randomized controlled trial design. Two authors will perform the selection of studies based on title and abstract, followed by a full-text review. A third author will intervene in cases of disagreements. Data will be recorded in a standardized worksheet and subjected to verification. The risk of bias will be assessed using the American Academy of Neurology tool. When applicable, a meta-analysis will be conducted. The efficacy of medications will be evaluated, categorizing them as "highly likely," "likely", or "possibly effective" or "ineffective." Subsequently, clinical recommendations will be developed, considering the risk associated with the medications, following the American Academy of Neurology recommendation development process.
The goal of this updated guideline will be to provide guidance on which injectable medications, including interventional approaches (i.e., nerve blocks, sphenopalatine ganglion), should be considered effective acute treatment for adults with migraine who present to an ED.
The methods outlined in this protocol will be used in the design of a future systematic review and meta-analysis-informed guideline, which will then be assessed by and submitted for endorsement by the American Headache Society.
本指南的主要目的是更新 2016 年关于成人在急诊科（ED）偏头痛发作时使用静脉内药物治疗的先前指南。
我们将使用 2016 年指南的方法进行更新的系统评价和荟萃分析，以提供临床建议。将使用相同的搜索策略搜索 2023 年之前的研究，并添加新的搜索策略以捕获神经阻滞和蝶腭神经节阻滞的研究。将搜索 Medline、Embase、Cochrane、clinicaltrials.gov 和世界卫生组织国际临床试验注册平台。我们的纳入标准包括涉及成人偏头痛诊断的研究，使用静脉内、肌肉内或皮下给予药物的随机对照试验设计。两名作者将根据标题和摘要进行研究选择，然后进行全文审查。如果存在分歧，第三名作者将进行干预。数据将记录在标准化工作表中，并进行验证。使用美国神经病学学会工具评估偏倚风险。在适用的情况下，将进行荟萃分析。评估药物的疗效，将其归类为“高度可能”、“可能”或“可能有效”或“无效”。随后，将根据美国神经病学学会的推荐制定程序，考虑与药物相关的风险，制定临床建议。
本指南更新的目标将是为静脉内药物治疗提供指导，包括介入方法（即神经阻滞、蝶腭神经节阻滞），应被视为急诊就诊的偏头痛成人有效的急性治疗方法。
本方案中概述的方法将用于设计未来的系统评价和荟萃分析指导，然后由美国头痛学会进行评估并提交认可。
