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Migraine in Primary Care Advisors

MIPCA Projects

Tailoring care to the needs of the individual patient

This project produced guidelines for the implementation of tailored care in migraine management. The recent publication of new MIPCA guidelines for migraine management has the potential to transform the management of migraine in primary care.

One of the key tenets of the new guidelines is the tailoring of care to the individual patient’s clinical and personal needs. Assessing migraine severity, by measuring the impact on the patient’s daily life, together with other assessments, allows the physician to prescribe therapies appropriate to the patient’s needs. All migraine patients require acute medications, with analgesic-based therapies (for mild-to-moderate migraine) and an appropriate triptan (for moderate-to-severe migraine) forming the logical options for initial therapy.

Rescue medications (generally a triptan or symptomatic medications) should also be provided for all patients.

Prophylaxis may be required for patients with frequent, disabling attacks, more complicated symptoms and for those who find acute medications ineffective or intolerable.

The first-line prophylactic therapy is usually a beta-blocker, but a serotonin antagonist, sodium valproate or amitriptyline are also effective and may be used if a beta-blocker is inappropriate. Prospective follow-up should be mandatory for all migraine patients, and acute medications may need to be switched if the initial therapy is shown to be ineffective. Prophylactic drugs require an adequate trial and also may be switched if shown to be ineffective after several months.

Patients refractory to repeated acute and prophylactic medications, and those having, or at risk of, chronic daily headache, should be referred to a specialist physician. Using this strategy of tailored care, the primary care physician should be able to manage the majority of migraine patients in their practice.

Reference

Lipscombe S, Rees T, Dowson AJ. Tailoring migraine management in primary care to the needs of the individual patient. Headache Care 2004;1:147–57.

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