2012 AHS/AAN Guidelines for Prevention of Episodic Migraine
2012 AHS/AAN Guidelines for Prevention of Episodic Migraine
Background.— Updated guidelines for the preventive treatment of episodic migraine have been issued by the American Headache Society (AHS) and the American Academy of Neurology (AAN). We summarize key 2012 guideline recommendations and changes from previous guidelines. We review the characteristics, methods, consistency, and quality of the AHS/AAN guidelines in comparison with recently issued guidelines from other specialty societies.
Methods.— To accomplish this, we reviewed the AHS/AAN guidelines and identified comparable recent guidelines through a systematic MEDLINE search. We extracted key data, and summarized and compared the key recommendations and assessed quality using the Appraisal of Guidelines Research and Evaluation-II (AGREE-II) tool. We identified 2 additional recent guidelines for migraine prevention from the Canadian Headache Society and the European Federation of Neurological Societies. All of the guidelines used structured methods to locate evidence and linked recommendations with assessment of the evidence, but they varied in the methods used to derive recommendations from that evidence.
Results.— Overall, the 3 guidelines were consistent in their recommendations of treatments for first-line use. All rated topiramate, divalproex/sodium valproate, propranolol, and metoprolol as having the highest level of evidence. In contrast, recommendations diverged substantially for gabapentin and feverfew. The overall quality of the guidelines ranged from 2 to 6 out of 7 on the AGREE-II tool.
Conclusion.— The AHS/AAN and Canadian guidelines are recommended for use on the basis of the AGREE-II quality assessment. Recommendations for the future development of clinical practice guidelines in migraine are provided. In particular, efforts should be made to ensure that guidelines are regularly updated and that guideline developers strive to locate and incorporate unpublished clinical trial evidence.
The American Headache Society (AHS) and the American Academy of Neurology (AAN) have issued updated guidelines for pharmacologic preventive treatment of episodic migraine. Migraine is a common, disabling, and costly disorder. There is no cure, but preventive treatment to decrease the number and severity of headache attacks improves health outcomes and quality of life. It also reduces disability and costs.
The AHS/AAN guidelines are the result of a systematic search, expert review, and synthesis of relevant evidence for preventive treatments of episodic migraine. The evidence identified in formulating the previous guidelines in 2000 was supplemented with evidence from a new search that extended through mid 2009.
Despite the availability of such up-to-date, evidence-based recommendations, research suggests that a majority of migraine sufferers who would benefit from prevention therapies do not receive them. Possible barriers to the adequate preventive treatment of migraine may be lack of physician awareness of the contents of clinical practice guidelines or a lack of confidence in the methodology and quality of such guidelines. Variability in guideline quality and consistency has been demonstrated in other therapeutic areas. One recent study on clinical practice guideline quality concluded that the quality of clinical practice guidelines improved only slightly over the past 2 decades.
We sought to summarize the key recommendations of the 2012 AHS/AAN guidelines and identify areas of change from the 2000 guidelines that they replace. In addition, we systematically review the quality and consistency of these guidelines in comparison with 2 other recent migraine prevention clinical practice guidelines.
Abstract and Introduction
Abstract
Background.— Updated guidelines for the preventive treatment of episodic migraine have been issued by the American Headache Society (AHS) and the American Academy of Neurology (AAN). We summarize key 2012 guideline recommendations and changes from previous guidelines. We review the characteristics, methods, consistency, and quality of the AHS/AAN guidelines in comparison with recently issued guidelines from other specialty societies.
Methods.— To accomplish this, we reviewed the AHS/AAN guidelines and identified comparable recent guidelines through a systematic MEDLINE search. We extracted key data, and summarized and compared the key recommendations and assessed quality using the Appraisal of Guidelines Research and Evaluation-II (AGREE-II) tool. We identified 2 additional recent guidelines for migraine prevention from the Canadian Headache Society and the European Federation of Neurological Societies. All of the guidelines used structured methods to locate evidence and linked recommendations with assessment of the evidence, but they varied in the methods used to derive recommendations from that evidence.
Results.— Overall, the 3 guidelines were consistent in their recommendations of treatments for first-line use. All rated topiramate, divalproex/sodium valproate, propranolol, and metoprolol as having the highest level of evidence. In contrast, recommendations diverged substantially for gabapentin and feverfew. The overall quality of the guidelines ranged from 2 to 6 out of 7 on the AGREE-II tool.
Conclusion.— The AHS/AAN and Canadian guidelines are recommended for use on the basis of the AGREE-II quality assessment. Recommendations for the future development of clinical practice guidelines in migraine are provided. In particular, efforts should be made to ensure that guidelines are regularly updated and that guideline developers strive to locate and incorporate unpublished clinical trial evidence.
Introduction
The American Headache Society (AHS) and the American Academy of Neurology (AAN) have issued updated guidelines for pharmacologic preventive treatment of episodic migraine. Migraine is a common, disabling, and costly disorder. There is no cure, but preventive treatment to decrease the number and severity of headache attacks improves health outcomes and quality of life. It also reduces disability and costs.
The AHS/AAN guidelines are the result of a systematic search, expert review, and synthesis of relevant evidence for preventive treatments of episodic migraine. The evidence identified in formulating the previous guidelines in 2000 was supplemented with evidence from a new search that extended through mid 2009.
Despite the availability of such up-to-date, evidence-based recommendations, research suggests that a majority of migraine sufferers who would benefit from prevention therapies do not receive them. Possible barriers to the adequate preventive treatment of migraine may be lack of physician awareness of the contents of clinical practice guidelines or a lack of confidence in the methodology and quality of such guidelines. Variability in guideline quality and consistency has been demonstrated in other therapeutic areas. One recent study on clinical practice guideline quality concluded that the quality of clinical practice guidelines improved only slightly over the past 2 decades.
We sought to summarize the key recommendations of the 2012 AHS/AAN guidelines and identify areas of change from the 2000 guidelines that they replace. In addition, we systematically review the quality and consistency of these guidelines in comparison with 2 other recent migraine prevention clinical practice guidelines.
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