CONSENSUS STATEMENT OF THE HELLENIC HEADACHE SOCIETY ON THE DIAGNOSIS AND TREATMENT OF MIGRAINE

Abstract

Migraine is one of the most prevalent diseases in medicine. The annual prevalence in Greece is about 8% in the age group 18-70 years old. In many cases of migraine attacks, when the intensity of pain is severe and the headache is refractory to acute treatment, then the functionality of the patient is ruined and becomes equivalent to tetraplegia. The collective disability of all migraineurs, measured in years lived with disability, ranks migraine second among all medical disorders and first in under 50s. Only a small minority of migraineurs seeks medical help, while the rest remain undiagnosed and untreated. The present consensus of experts guided by the Hellenic Headache Society aims to increase migraine awareness in Greece, to support Greek practitioners who are engaged in migraine diagnosis and treatment and to offer to the patients the most individualized treatment option. Symptomatic treatment of mild cases should begin with high-dose simple analgesics. For moderate to severe cases non-steroidal anti-inflammatory drugs or triptans or a combination of both should be prescribed, along with a rescue medication (e.g. subcutaneous sumatriptan). First line preventative treatment for episodic migraine includes topiramate (25-100 mg/d), propranolol (40-240 mg/d), metoprolol (50-200 mg/d), candesartan (16-32 mg/d) flunar-izine (5-10 mg/d) and valproate (500-1800 mg/d). First line preventative treatment for chronic migraine includes drugs with lower level of evidence, namely topiramate (100-200 mg/d), flunarizine (5-10 mg/d), valproate (500–1800 mg/d), and venlafaxine (150 mg/d). The anti-CGRP monoclonal antibodies (mAbs) and Botulinum Toxin A may be administered as second line treatment for chronic migraine, following two previous preventative treatment failures (either due to ineffectiveness or intolerance). In addition, an-ti-CGRP mAbs may be administered in high frequency episodic migraine, defined by ≥8 migraine days per month and ≤14. Finally, various neurostimulation devices, as well as food supplements may be offered to the migraineurs with drug avoidance behavior, or drug intolerance, contraindication or ineffectiveness.