Addendum to Clinical Guideline 150, Headaches in Over 12S: Diagnosis and Management
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National Institute for Health and Care Excellence DocumentFinal information (version number/stage of process) Addendum to Clinical Guideline 150, Headaches in over 12s: diagnosis and management Clinical Guideline Addendum 150.1 Methods, evidence and recommendations November 2015 Final version Developed by the National Institute for Health and Care Excellence Clinical Guideline 150.1 (Headaches(Headaches)) Contents Disclaimer Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer. Copyright © National Institute for Health and Care Excellence, 2015. All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the express written permission of NICE. Clinical guideline 150.1 (Headaches) Contents Contents Clinical guidelines update .................................................................................................. 6 1 Summary section.......................................................................................................... 7 1.1 Update information ................................................................................................ 7 1.2 Patient-centred care .............................................................................................. 8 1.3 Methods ................................................................................................................ 9 2 Evidence review and recommendations ................................................................... 10 2.1 Introduction ......................................................................................................... 10 2.2 Review question .................................................................................................. 10 2.3 Clinical evidence review ...................................................................................... 10 2.3.1 Methods ................................................................................................... 10 2.3.2 Results ..................................................................................................... 12 2.4 Health economic evidence review ....................................................................... 18 2.4.1 Methods ................................................................................................... 18 2.4.2 Results of the economic literature review ................................................. 21 2.4.3 De novo economic modelling ................................................................... 21 2.4.4 Unit cost of prophylactic medicines .......................................................... 21 2.5 Evidence statements ........................................................................................... 26 2.5.1 Clinical evidence statements .................................................................... 26 2.5.2 Health economic evidence statement ....................................................... 27 2.6 Evidence to recommendations ............................................................................ 27 2.7 Recommendations .............................................................................................. 30 3 References .................................................................................................................. 32 4 Glossary and abbreviations ....................................................................................... 35 Appendices ........................................................................................................................ 36 Appendix A: ............................................ Standing Committee members and NICE teams 36 A.1 Core members ......................................................................................... 36 A.2 Topic expert Committee members ........................................................... 36 A.3 NICE project team .................................................................................... 36 A.4 Clinical guidelines update team ................................................................ 37 Appendix B: .................................................................................. Declarations of interest 38 Appendix C: ............................................................................................. Review protocol 48 Appendix D: .............................................................................................. Search strategy 50 Appendix E: ............................................................................................ Review flowchart 55 Appendix F: ............................................................................................ Excluded studies 56 Appendix G: ............................................................................................ Evidence tables 72 G.1 Included studies ....................................................................................... 76 Appendix H: ............................................................................................. GRADE profiles 188 Appendix I: Forest plots .............................................................................................. 202 4 Clinical guideline 150.1 (Headaches) Contents Appendix J: ................................................................................... Network meta-analysis 223 J.1 Implementation ...................................................................................... 225 J.2 WinBUGS code ...................................................................................... 225 J.3 Validation ............................................................................................... 225 J.4 Results ................................................................................................... 227 J.5 Quality assessment ................................................................................ 231 Appendix K: .............................................................................. Economic search strategy 233 Appendix L: .............................................................................Economic review flowchart 239 Appendix M: ...........................................................................Excluded economic studies 240 Appendix N: ............................................................................. Economic evidence tables 242 Appendix O:Cost-effectiveness analysis of prophylactic pharmacological treatment for migraine 253 O.1 Introduction ............................................................................................ 253 O.2 Overview ................................................................................................ 253 O.3 Parameters ............................................................................................ 256 O.4 One-way sensitivity analyses ................................................................. 257 O.5 Results ................................................................................................... 260 O.6 Discussion ............................................................................................. 263 Appendix P: .......................... WinBUGS code for cost-effectiveness analysis (base case) 265 Appendix Q: .......... WinBUGS code for meta-analysis of dropouts due to adverse events 271 5 Clinical Guideline 150.1 (Headaches) Clinical guidelines update Clinical guidelines update The NICE Clinical Guidelines Update Team update discrete parts of published clinical guidelines as requested by NICE’s Guidance Executive. Suitable topics for update are identified through the new surveillance programme (see surveillance programme interim guide). These guidelines are updated using a standing Committee of healthcare professionals, research methodologists and lay members from a range of disciplines and localities. For the duration of the update the core members of the Committee are joined by up to 5 additional members who have specific expertise in the topic being updated, hereafter referred to as ‘topic expert members’. In this document where ‘the Committee’ is referred to, this means the entire Committee, both the core standing members and topic expert members. Where ‘standing committee members’ is referred to, this means the core standing members of the Committee only. Where ‘topic expert members’ is referred to this means the recruited group of members with topic expertise. All of the core members and the topic expert members are fully voting members of the Committee. Details of the Committee membership and the NICE team can be found in appendix A. The Committee members’ declarations of interest can be found in appendix B. 6 Clinical Guideline 150.1 (Headaches) Summary section 1Summary section 1.1 Update information The NICE guideline on headaches (NICE clinical guideline CG150) was reviewed in 2013 as part of NICE’s routine surveillance programme to decide whether it required updating. The surveillance report identified new evidence relating to pharmacological treatment for the prevention of migraine. The full report can be found here: https://www.nice.org.uk/guidance/cg150/resources/headaches-surveillance-review-