Severe migraine and its control: A proposal for definitions and consequences for care |
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Institution: | 1. Centre d’évaluation et de traitement de la douleur, CHU de la Timone, Marseille, France;2. Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France;3. Service de Neurologie, CHU Gui de Chauliac, Montpellier, France;4. Unité de traitement de la douleur chronique, CHU de Bordeaux, Bordeaux, France;5. Novartis Pharma, Rueil-Malmaison, France;6. Département d’évaluation et de traitement de la douleur CHU de Nice, FHU InovPain Université Côte Azur, Nice, France;1. Inserm, Lille Neurosciences and Cognition, CHU de Lille, University Lille, 59000 Lille, France;2. Clinical Investigation Center, Lille University Medical Center, Lille, France;3. Neurology and Movement Disorders, Lille University Medical Center, Lille, France;4. EA 2694 – METRICS : évaluation des technologies de santé et des pratiques médicales, CHU de Lille, University Lille, Lille, France;5. MoCA Clinic & Institute, Quebec, Canada;1. Department of Neurology, Suining Central Hospital, Suining 629000, China;2. Department of Internal Medicine, the Third People''s Hospital of Suining, Suining 629099, China |
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Abstract: | Currently many patients with severe migraine do not receive appropriate treatment and are never referred to specialist headache centres. On the other hand, specialist headache centres are frequently attended by patients whose migraines could be managed adequately in the community. One reason for this may be the absence of standardised definitions of migraine severity and control and of a treatment algorithm for orientating difficult-to-treat patients to specialist headache centres. Based on a review of the relevant literature and consensus meetings, proposals have been made for these items. We propose that migraine should be considered severe if headache frequency is at least eight migraine days per month or, if headaches are less frequent, the HIT-6 score is ≥ 60 or ≥ 50% of headaches require complete interruption of activity. The proposed definition of migraine control is defined on the basis of appropriate response to acute headache therapy and to preventative therapy. A treatment algorithm is proposed to assess migraine control regularly and to adapt therapy accordingly. These proposals may contribute to developing and testing strategies for management of severe disease with appropriate and effective preventive treatment strategies. With the anticipated introduction of new possibilities for migraine prevention in the near future, the time is ripe for a holistic approach to migraine management. |
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Keywords: | Severe migraine Difficult-to-treat patients Prevention |
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