[Guideline for primary care management of headache in adults].

Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Quality of evidence A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Main message A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Conclusion A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache. Guideline for primary care management of headache in adults Werner J. Becker MD FRCP(C) Ted Findlay DO CCFP Carmen Moga MD MSc N. Ann Scott PhD Christa Harstall MHSA Paul Taenzer PhD RPsych EDITOR’S KEY POINTS • Headache is a common reason why patients seek help from family physicians, and treatment is often suboptimal. This article outlines the development and key recommendations of the clinical practice guideline created by a multidisciplinary guideline development group to assist Canadian primary care practitioners with providing evidence-informed care for patients with headache. • Migraine, which is historically underdiagnosed, is by far the most common headache type in patients seeking help for headache. Neuroimaging, sinus or cervical spine x-ray scans, and electroencephalograms are not recommended for the routine assessment of patients with headache: history and physical and neurologic examination findings are usually sufficient to make a diagnosis. Comprehensive migraine therapy includes management of lifestyle factors and triggers, acute and prophylactic medications, and migraine selfmanagement strategies. Treatment of tensiontype, cluster, and medication-overuse headache is also outlined. This article is eligible for Mainpro-M1 credits. To earn credits, go to www.cfp. ca and click on the Mainpro link. This article is eligible for Mainpro-M1 credits. To earn credits, go to www.cfp. ca and click on the Mainpro link. This article has been peer reviewed. Can Fam Physician 2015;61:670-9 La traduction en français de cet article se trouve à www.cfp. ca dans la table des matières du numéro d’août 2015 à la page e353. Headache is one of the most common reasons patients seek help from family physicians. The estimated lifetime prevalence of headache is 66%: 14% to 16% for migraine, 46% to 78% for tension-type headache, and 0.1% to 0.3% for cluster headache.1-3 In Canada, at least 2.6 million adult women and nearly 1 million men experience migraine.4 About 90% of migraine sufferers report moderate to severe pain, with 75% reporting impaired function and 33% requiring bed rest during an attack.5 The economic effects of headache are also substantial. It is estimated that headache accounts for 20% of work absences.6 Vast quantities of over-the-counter medications are taken for headache disorders, and treatment is often suboptimal.1,7 Although most migraine sufferers use acute treatment to relieve their headaches, a substantial number of people who might benefit from prophylactic therapy do not receive it— more than 1 in 4 migraineurs are candidates for preventive therapy.5,8 Better information and education for patients and health professionals is essential to improving management of headache in primary care, which should lead to prompt diagnosis and more effective treatment.9 To help address this, a consortium of organizations and clinicians from Alberta developed the Guideline for Primary Care Management of Headache in Adults.10