Implementation and impact of headache guidelines

Hans-Christoph Diener, Fabio Antoncai, Emile Couturier, Peter J Goadsby, Rigmor Jensen, Jose M Láinez, Richard B Lipton, Ivan Milanov, Dimos Mitsikostas, Peter Sandor, Jean Schoenen, Dominique Valade and Maria Wysocka-Bakowska

in Headache care, research and education worldwide

Published on behalf of Oxford University Press

Published in print May 2010 | ISBN: 9780199584680
Published online November 2012 | e-ISBN: 9780191753435 | DOI:

Series: Frontiers in Headache Research Series

Implementation and impact of headache guidelines

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In the age of evidence-based medicine, diagnosis and treatment of headache should be based on guidelines. Many countries have guidelines for the treatment of headache. These are also available for Europe and for GPs. Little, however, is known about the implementation of guidelines and whether they affect treatment strategies or prescriptions. The first guidelines for the treatment of migraine were published in Germany in 2002. These guidelines recommended the use of triptans for moderate or severe migraine attacks and for attacks not responding to simple analgesics or NSAIDs. Market research performed by Glaxo at that time prior to and 6 months after the publication of the guideline showed no change in the prescription rates for triptans. The same was true for drugs recommended for the prophylaxis of migraine.

What are the reasons for this observation and how can the situation be improved? 1. Guidelines should not only be published in specialist journals but also in journals read by GPs. 2. Pharmaceutical companies can be critical in distributing guidelines via their representatives. 3. Guidelines might be too complex and the symbols for evidence can be confusing. 4. Recommendations might be scientifically correct but in the context of reimbursement in a particular country, physicians might not be able to implement them. 5. Some drugs that are clearly effective such as valproic acid are not approved in Europe and cannot be prescribed for the indication migraine prophylaxis.

The implementation of guidelines can be assessed using both quantitative and qualitative measures. Tracking prescription patterns in databases and surveying doctors and patients provide quantitative measures. Feedback from physicians (i.e. from teaching courses) and patients provides a qualitative means for assessing guideline implementation. For example, the German Neurological Society organizes several teaching courses every year designed to teach the content of its guidelines and to get critical feedback on ways to improve the guidelines.

In the following part, headache specialists from different countries report their experience with headache guidelines and the implementation in their country.

Chapter.  2840 words. 

Subjects: Neurology

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