AMBASSADOR PROGRAM GUIDELINE FOR MANAGEMENT OF PRIMARY HEADACHE IN ADULTS BACKGROUND DOCUMENT (SUPPORTING DOCUMENTS AND PROCESS DESCRIPTION) AUGUST 2013 August, 2013 ABBREVIATIONS CPG clinical practice guideline CS case series study EO expert opinion G guideline G1 to G6 seed guidelines GDG Guideline Development Group HTA health technology assessment IHE Institute of Health Economics IHS International Headache Society MA meta-analysis NA not applicable NR narrative review NRCS non-randomized comparative study NRT non-randomized trial NSAID non-steroidal anti-inflammatory drug qSR quasi-systematic review RCT randomized controlled trial SC Steering Committee SR systematic review TOP Toward Optimized Practice Ambassador Program. Guideline for Management of Primary Headache in Adults. Background Document i August, 2013 TABLE OF CONTENTS Abbreviations ...................................................................................................................................................... i Scope of this Document ................................................................................................................................... 1 About the Alberta Headache Guideline ......................................................................................................... 2 Purpose ............................................................................................................................................................ 2 Objectives ........................................................................................................................................................ 2 Target Users .................................................................................................................................................... 2 Multidisciplinary Participation ...................................................................................................................... 2 Guideline Documents .................................................................................................................................... 3 For clinicians ................................................................................................................................................ 3 For patients .................................................................................................................................................. 4 Conflict of Interest ......................................................................................................................................... 4 Funding and Editorial Independence .......................................................................................................... 4 Legal Aspects .................................................................................................................................................. 4 Terms of Use ................................................................................................................................................... 4 Stage I – Set-Up: Background and Planning ............................................................................ 6 Overview of the Alberta Ambassador Guideline Adaptation Program ................................................. 6 Set-up and Planning of the Alberta Headache Guideline Development Process ................................. 7 About Headache ............................................................................................................................................. 8 Summary of the epidemiology and disease burden of common headache disorders ....................... 8 Knowledge gaps in the primary care treatment of headache disorders ............................................ 10 References ...................................................................................................................................................... 12 Stage II – Adaptation: Identifying, Selecting, and Appraising the Seed Guidelines .............. 15 Rationale ........................................................................................................................................................ 15 Identifying Seed Guidelines ........................................................................................................................ 16 Inclusion criteria ........................................................................................................................................ 16 Exclusion criteria ....................................................................................................................................... 17 Literature search strategies ....................................................................................................................... 17 Selecting the Seed Guidelines ..................................................................................................................... 23 Critically Appraising the Seed Guidelines ................................................................................................. 24 Ambassador Program. Guideline for Management of Primary Headache in Adults. Background Document ii August, 2013 Extracting Data ............................................................................................................................................. 25 References ...................................................................................................................................................... 26 Stage II – Adaptation: Guideline Development Process ........................................................ 28 General Process ............................................................................................................................................ 28 Rationale and Process for Developing Recommendations .................................................................... 32 Classification of Recommendations .......................................................................................................... 33 Limitations of the Guideline Development Process ............................................................................... 34 References ...................................................................................................................................................... 35 Stage III – Finalization: Reviewing, Evaluating, and Endorsing the Guideline .................... 36 Reviewing the Alberta CPG ........................................................................................................................ 36 GDG and their colleagues ....................................................................................................................... 36 Primary care practitioners ........................................................................................................................ 37 Advisory committee .................................................................................................................................. 37 Patients and lay people ............................................................................................................................. 37 Endorsement ................................................................................................................................................. 38 Evaluation Strategy ....................................................................................................................................... 38 Key review criteria .................................................................................................................................... 38 References ...................................................................................................................................................... 40 Stage III – Finalization: Disseminating, Implementing, and Updating the Guideline ......... 41 Potential Barriers to Guideline Uptake and Implementation ................................................................ 41 Key actors ................................................................................................................................................... 42 Dissemination and Implementation Plan.................................................................................................. 44 Update Process ............................................................................................................................................. 44 References ...................................................................................................................................................... 48 Applicability of the Guideline – Economic/Cost Implications .............................................. 49 General Aspects ............................................................................................................................................ 49 Economic Information Reported in the Seed Guidelines ...................................................................... 50 Resource Implications of the Alberta CPG .............................................................................................. 50 References ...................................................................................................................................................... 50 Ambassador Program. Guideline for Management of Primary Headache in Adults. Background Document iii August, 2013 Appendix A: Participants