Diagnostic and therapeutic guidelines for migraine. Italian Society for the Study of Headaches (SISC)

Abstract

The Italian Society for the Study of Headaches (SISC) published the first guidelines for diagnosis and treatment of migraine in 1993. In 2000, the Executive Committee of the SISC decided to provide updated diagnostic and therapeutic guidelines for migraine and cluster headache for headache experts and physicians dedicated to headaches. For this purpose an Ad Hoc Committee was formed, taking into consideration the multidisciplinary characteristics of the society, and was composed of prominent Italian researchers from various disciplines. The guidelines were published in 2001 and will be updated each year on the basis of new information concerning diagnostic and therapeutic strategies for migraine and cluster headache. The Ad Hoc Committee was organized into subcommittees, each responsible for a different topic: diagnosis of migraine; symptomatic treatment of migraine; prophylactic treatment of migraine; non–pharmacological treatment of migraine; diagnosis, symptomatic and prophylactic treatment of cluster headache; and lastly trigeminal autonomic cranial neuralgias (TACs) and unsolved questions. The present paper reports the major conclusions of the first three subcommittees only. From a methodological point of view, it was decided that all the information reported in the guidelines would be evidencebased. This involved a thorough research on Medline and Pubmed taking into consideration all the articles concerning clinical, laboratory and instrumental examinations and therapeutic approaches for migraine and cluster headache. As far as migraine is concerned, all studies available in the literature examining the sensitivity, specificity, predictive value of clinical history, neurological examination, laboratory tests and instrumental examination were evaluated to identify variables useful in the differential diagnosis of secondary headaches mimicking migraine attacks and to identify surrogate indicators of migraine. Four groups of recommendations, based on the levels of evidence, scientific effect and clinical assessment were defined for all symptomatic and prophylactic drugs. Information regarding clinical contraindications and pharmacological interactions for each class of symptomatic and prophylactic anti-migraine drugs were also reported.