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Migraine in Primary Care Advisors

MIPCA

Below are news releases from MIPCA:

 


News release: January 2007

Review of migraine treatments available in the UK

Summary

New to the MIPCA website is an article reviewing migraine treatments available in the UK which can be recommended for use in the clinic on the basis of clinical evidence. All the treatments have Grade A evidence of clinical effectiveness from at least one meta-analysis of randomised controlled trials and/or at least one randomised controlled trial. We plan this to be a dynamic document that is updated with new clinical evidence. We therefore welcome your comments and input to .

Below is the full document in Adobe® PDF format:

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Document release: October 2006

Competencies Framework

Headache – General Practitioners with a Special Interest

Summary

Below is the full document in Adobe® PDF format:

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News release: August 2006

Beta-blockers

Currently there is concern regarding the prescription of beta blockers for high blood pressure. NICE has recommended that they no longer be used as first-line treatment for hypertension. However, beta blockers are also used as first-line preventive treatment for migraine. The City of London Migraine Clinic and the Migraine Action Association have issued a joint statement which provides reassurance as to the safety of these drugs when used for migraine, which is reprinted below.

In view of the recent NICE recommendations should I continue to take beta blockers for migraine prevention?

Don’t panic. There is no cause for concern. The NICE recommendations relate to the treatment of hypertension, NOT migraine. The studies showed that, compared with other drugs used to treat hypertension, beta blockers were usually less effective at reducing major cardiovascular events, in particular stroke. For this reason, they are no longer recommended as the initial treatment for most people with hypertension although they still have a place in the management of this condition. There is no evidence that beta blockers are unsafe (in a general population) and they remain an effective migraine preventative. They were first developed over 40 years ago and were found to reduce blood pressure. Since then, millions of people worldwide have been taking them daily for very long periods of time. Serendipitously, they were found also to help to reduce the frequency and severity of migraine and are now licensed for this purpose.

Hence, if you are taking beta blockers solely for migraine prevention, there is no reason why you should not continue. If you are taking beta blockers to control high blood pressure as well as preventing migraine, your doctor may consider that it is appropriate for you to continue them. If treatment with the beta blocker is not working, then your GP may recommend a different drug. Discuss the options with your GP or headache specialist at your next review (or when your next repeat prescription is due). These are the best people to advise you as they have access to your full medical history.

Further information on the new guidelines for the treatment of hypertension is available from the NICE website: www.nice.org.uk/page.aspx?o=cg034publicinfo Reprinted with permission from the Migraine Action Association (www.migraine.org.uk) and the City of London Migraine Clinic (www.colmc.org.uk).

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News release: July 2006

A new postgraduate course on headache management

MIPCA is proud to announce a new Postgraduate Certificate for the Management of Headache in Primary Care, which is now enrolling students and is due to commence in Autumn 2006. The course is being run by the Faculty of Health at the University of Central Lancashire (UCLan) at Preston in association with MIPCA and the Migraine Action Association (MAA).

The Postgraduate Certificate Management of Headache in Primary Care is a new and innovative course providing a professional qualification and potential for further career development. This course supports the development of healthcare practitioner roles that involve the management and treatment of headaches, such as GPs, GPs with Special Interests (GPSIs), nurses and pharmacists. It has been designed to be topical in its content, incorporating:

  1. The government’s white paper on increasing care delivery in the community, rather than via hospital care.
  2. State of the art guidelines for headache management both in the UK (MIPCA guidelines) and internationally (US Headache Consortium and International HCPC guidelines).
  3. Good clinical practice (GCP) guidelines.
  4. The evidence base, which forms the basis of the course, is continually updated according to NICE recommendations.

A holistic approach to care is central to this course where participants become patient advocates, placing them at the centre of care, as specified within the new NHS contracts. It will provide best practice for the diagnosis, management and delivery of a headache service in primary care, which would be particularly suited to healthcare professionals who want to improve their headache skills and/or for those wanting to progress into Special Interest positions. The course is in three modules, covering headache science and principles of care in Part 1, headache treatments in Part 2 and a practice-based module in Part 3. Each module earns the qualification of a University Certificate, two courses earn an Advanced Certificate and all three courses a Postgraduate Certificate.

This is the first postgraduate course designed for prospective GPSIs and it is hoped that it will provide a model for other disease areas. Interested professionals (GPs, nurses, pharmacists and other healthcare professionals with an interest in headache) are encouraged to contact UCLan for further information and an application pack by phone on 01772 893805 or by email at:

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News release: July 2006

Switching sumatriptan tablets from prescription only (POM) to pharmacy prescription (P) status

The decision of the UK Medicines and Healthcare products Regulatory Agency (MHRA) to approve the POM to P switch of sumatriptan 50 mg tablets (Imigran Migraine Relief®, GlaxoSmithKline) indicates a major change in the provision of acute medications to migraine sufferers. The availability of sumatriptan 50 mg in the pharmacy provides the sufferer with a wider choice of treatments they can purchase for migraine and means they can now use sumatriptan without seeing a GP.

However, there are two issues to consider before we are able to wholeheartedly support this initiative:

  1. Triptans are very effective acute treatments, but are associated with contraindications, special warnings and side effects that must be taken into account before an OTC sale can be made. In particular, they are contraindicated in people with a risk of cardiovascular disease. To deal with these issues, the pharmacist must complete a questionnaire with the patient to identify patients with risk factors before a sale is made. This questionnaire has been validated and approved by the MHRA.
  2. The pharmacist needs to look out for patients overusing acute migraine medications and developing medication overuse headache (MOH). This can occur with triptans as well as with analgesics and ergots. Research shows that about 10% of people prescribed triptans use inappropriate high amounts. However, the cost of OTC sumatriptan (£7.99 for two tablets) is considerably more than a prescription and may well drive high users to consult a GP.

All these data support the switch of sumatriptan from POM to P status, and this principle has been supported by the major UK medical charities that deal with headache (MIPCA, British Association for the Study of Headache [BASH], Migraine Action Association [MAA] and the Migraine Trust. Evidence-based guidelines have been produced for pharmacists to help them manage people with migraine and other headaches, providing treatment or advising them to consult a GP (available on this website).Use of these guidelines, together with the pharmacist questionnaire, should give the pharmacist the information they require to sell sumatriptan safely and effectively.

Overall, the switch of sumatriptan 50 mg tablets from POM to P status is to be welcomed. It should enable more migraine sufferers to be treated effectively than is the case at present. The safeguards built in to the process should also minimise potential problems associated with the drug. The switch provides the community pharmacist with an enhanced role in the management of migraine, as advocated by current management guidelines, and to become a key member of the primary care headache team. Ongoing educational initiatives will be required to promote and maintain the role of pharmacists in headache management, and suitable courses are currently in development (see the news item above on the Masters courses at the University of Central Lancashire).

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News release: July 2006

Guidelines on the management of headaches for opticians

MIPCA welcomes the publication of two articles in Optician providing guidelines on the management of headaches for opticians.1,2 This initiative was part of the MIPCA Pharmacy Programme (see elsewhere on the website) and the authors are a group of opticians, pharmacists and physicians.

The articles review:

MIPCA has now published evidence-based guidelines for the GP on how to manage migraine and chronic headaches, and to the nurse, pharmacist, optician and patient on how to manage migraine (see this website). Such comprehensive guidance is hard to find elsewhere in the medical field.

References
  1. Glover C, Greensmith S, Ranftler A et al. Guidelines on the management of headaches – Part 1. Optician 2006;231:20–23.
  2. Glover C, Greensmith S, Ranftler A et al. Guidelines on the management of headaches – Part 2. Optician 2006;231:34–39.

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