Hoydonckx Yasmine, Feoktistov Alexander, Amoozegar Farnaz, Anderson Christopher C, Barad Meredith, Burke Emeralda, Chitsantikul Prin, Doshi Tina L, Englesakis Marina, Goel Akash, Gupta Himanshu, Kissoon Narayan, Kirschner Aaron, Kohan Lynn, Lauritsen Clinton G, Miller Franziska, Monsour Danny, Nader Antoun, Ogunlaja Oyindamola, Schuster Nathaniel, Schwenk Eric S, Silberstein Stephen D, Souza Dmitri, Yuan Hsiangkuo, Narouze Samer
Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Reg Anesth Pain Med. 2025 Jul 2. doi: 10.1136/rapm-2025-106718.
Patients hospitalized for headache treatment pose unique challenges to the healthcare system. Currently, there is a lack of evidence-based guidance on management. This practice advisory aims to fill this critical gap by systematically reviewing the existing literature and providing comprehensive, evidence-based recommendations for managing headache patients during hospitalization.
In February 2023, the American Society of Regional Anesthesia and Pain Medicine approved this practice advisory proposal. The steering committee selected committee members based on clinical and research expertise in the field of headache medicine. Nine questions were formulated by the committee, and each question was assigned to a group composed of 3-4 members. A systematic literature search for each question was performed in Medline, Embase, Cochrane Database of Systematic Reviews and Web of Science on June 21, 2023. The results from each search were imported into separate Covidence projects for screening, data extraction, and risk of bias assessment. Additionally, relevant systematic reviews (SR) were screened. Each group submitted a structured narrative review along with statements and recommendations based on the US Preventive Services Task Force (USPSTF) format for grading of evidence. While the USPSTF framework was used, including the language in the recommendations, the formal USPSTF methodology, including the SR with meta-analysis and summary tables with forest plots, was not followed because of low overall evidence quality. The interim draft was shared electronically with each collaborator, who was requested to vote anonymously using two rounds of the modified Delphi approach. A consensus recommendation required >75% agreement.
The panel generated 12 statements and 17 recommendations, along with their strength and certainty of evidence. Following two rounds of Delphi voting, a high consensus was achieved for all statements and recommendations. Most statements received a low-to-moderate level of certainty, and all but one recommendation received grade B or C, which was consistent with the lack of randomized controlled trials supporting most of the drugs in this document.
This evidence-based practice advisory provides a foundational step toward standardizing inpatient headache care and highlights existing gaps in the literature that should be addressed through rigorous prospective randomized studies.
因头痛接受住院治疗的患者给医疗系统带来了独特的挑战。目前，在管理方面缺乏循证指南。本实践指南旨在通过系统回顾现有文献，并为住院期间头痛患者的管理提供全面的、循证建议，来填补这一关键空白。
2023年2月，美国区域麻醉和疼痛医学学会批准了本实践指南提案。指导委员会根据头痛医学领域的临床和研究专业知识挑选委员会成员。委员会提出了9个问题，每个问题分配给一个由3 - 4名成员组成的小组。2023年6月21日，在Medline、Embase、Cochrane系统评价数据库和科学网对每个问题进行了系统的文献检索。每次检索的结果被导入单独的Covidence项目进行筛选、数据提取和偏倚风险评估。此外，还筛选了相关的系统评价（SR）。每个小组提交了一份结构化的叙述性综述，以及基于美国预防服务工作组（USPSTF）证据分级格式的陈述和建议。虽然使用了USPSTF框架，包括建议中的语言，但由于总体证据质量较低，未遵循正式的USPSTF方法，包括带有荟萃分析的SR和带有森林图的汇总表。临时草案通过电子方式与每位合作者共享，要求他们使用两轮改良的德尔菲方法进行匿名投票。达成共识的建议需要超过75%的同意率。
该小组提出了12条陈述和17条建议，以及它们的证据强度和确定性。经过两轮德尔菲投票，所有陈述和建议都达成了高度共识。大多数陈述的确定性水平为低到中等，除一项建议外，所有建议的等级为B或C，这与本文档中大多数药物缺乏随机对照试验相一致。
本循证实践指南为规范住院头痛护理迈出了基础性的一步，并突出了文献中应通过严格的前瞻性随机研究加以解决的现有空白。
