J Headache Pain (2007) 8:S1 DOI 10.1007/s10194-007-0366-y Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide in collaboration with European Headache Federation Aids for management of common headache disorders in primary care This is a "Springer Open Choice" article. Unrestricted non-commercial use, distribution, and reproduction in any medium is permitted, provided the original author and source are credited. J Headache Pain (2007) 8:S2 PREFACE T.J. Steiner Aids for management of common headache P. Martelletti disorders in primary care T.J. Steiner Medical management of headache Whilst the focus of this publication Chairman: Global Campaign Committee disorders, for the vast majority of is Europe, these management aids Lifting The Burden people affected by them, can and have been developed to be useful should be carried out in primary cross-culturally and may suit a P. Martelletti care. It does not require specialist wider population. Editor-in-Chief Journal of Headache and Pain skills. Nonetheless, it is recognised The European principles of that non-specialists throughout management of common headache Europe may have received limited disorders in primary care are the training in the diagnosis and treat- essential core of these aids. These ment of headache. are set out in 12 sections, each one This special supplement of Journal more-or-less stand-alone. They are of Headache and Pain is the out- supplemented in Appendices 1 and put of a collaboration between the 2 by a measure of headache burden European Headache Federation (the HALT index), intended for (EHF) and Lifting The Burden: the pre-treatment assessment of illness Global Campaign to Reduce the severity, an outcome measure (the Burden of Headache Worldwide, a HART index), which is a guide to programme for the benefit of peo- follow-up and need for treatment- ple with headache conducted under review, and a series of patient the auspices of the World Health information leaflets developed to Organization. It contains a set of improve patients’ understanding of management aids designed by vari- their headache disorders and their ous specialist working groups management. expressly to assist primary-care EHF and Lifting The Burden offer physicians in managing a group of these aids freely available for use very common disorders effectively. without restriction. They will need We hope for benefits for both translating into many languages. patients and physicians. In the first Therefore, also included, in case, there should be better Appendix 3, are a set of translation outcomes for the many people with protocols. These have been pre- headache who need medical pared by a working group of treatment. In the second, Lifting The Burden to ensure that physicians are helped to deliver translations as far as possible are appropriate care more efficiently unchanged in meaning from the and more cost-effectively. English-language originals. This work was performed under a collaborative arrangement between World Health Organization and World Headache Alliance, International Headache Society and European Headache Federation ©WHO, WHA, IHS, EHF J Headache Pain (2007) 8:S3 GUIDELINES T.J. Steiner European principles of management of K. Paemeleire R. Jensen common headache disorders in primary care D. Valade L. Savi M.J.A. Lainez H.-C. Diener P. Martelletti E.G.M. Couturier on behalf of the European Headache Federation and Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide T.J.Steiner Division of Neuroscience and Mental Health, Imperial College London, London, UK K. Paemeleire Department of Neurology, Ghent University Hospital. Ghent, Belgium R. Jensen Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark D. Valade Introduction specialist care whenever necessary. Centre d'Urgence des Céphalées, Hôpital Lariboisière, Paris, France These principles are likely to be Headache disorders are amongst the most useful if read through at least L. Savi top ten causes of disability in once in their entirety, but are set Headache Centre, Department of Neurosciences, Europe [1]. Three of these out in 12 stand-alone management University of Turin, Italy (migraine, tension-type headache aids in three sections: M.J.A. Lainez and medication-overuse headache) Department of Neurology, University Clinic are important in primary care Guides to diagnosis (some parts of Hospital, Valencia University, Valencia, Spain because they are common and these will need to be assimilated into H.-C. Diener responsible for almost all headache- routine practice whereas other parts Department of Neurology, University of related burden. Their management can serve as check lists and aide- Duisberg-Essen, Essen, Germany belongs largely in primary care. A mémoires) P. Martelletti fourth headache disorder (cluster 1. Headache as a presenting com- Department of Medical Sciences, Regional headache) is also important because plaint Referral Headache Centre, Sant’Andrea Hospital, Sapienza University, Rome, Italy it is severely painful, treatable but 2. Diagnosis of headache often misdiagnosed. 3. Typical features of the common E.G.M. Couturier The purpose of these principles is headache disorders Medisch Centrum Boerhaave, Amsterdam, The Netherlands to help primary-care physicians 4. Differential diagnosis of the com- correctly diagnose these few disor- mon headache disorders E.G.M. Couturier (౧) Medisch Centrum ders, manage them well when they Boerhaave, Johannes Vermeerstr 31, 1071 DL can, recognise warnings of serious Guides to management (these are Amsterdam, The Netherlands. E-mail: [email protected] headache disorders and refer for information sources to be referred to S4 once the diagnosis has been made; management aid #6 Evidence-based recommendations were always preferred to includes guidance on information to patients) those without explicit supporting evidence. Discordance 5. General aspects of headache management between recommendations was resolved through direct refer- 6. Advice to patients ence to original evidence or, where this was lacking, through 7. Medical management of acute migraine consensus of expert opinion. 8. Prophylactic management of migraine 9. Medical management of tension-type headache 10. Medical management of cluster headache Clarity and presentation 11. Management of medication-overuse headache The aim was to give straightforward and easily-followed Guide to referral (a reference and reminder) guidance to primary-care physicians who were assumed to be 12. Headache management in primary care: when to refer non-expert. There was recognition that availability and regu- latory approval of drugs and reimbursement policies varied These principles are supplemented by additional manage- from country to country. For that reason, different possible ment aids developed by Lifting The Burden: options were considered and are set out wherever appropriate, but otherwise the emphasis was on unambiguous advice. • the Headache-Attributed Lost Time (HALT) index, a measure of headache burden • the Headache and Assessment of Response to Treatment Applicability (HART) index, a measure of treatment effect and guide to follow-up These principles assume that headache services are developed • a series of patient information leaflets. and adequately resourced in all countries in Europe, even though this is not the case at present. Separate initiatives by EHF and Lifting The Burden are being undertaken to support better organisation of headache services in all countries in Development process Europe. These recommendations will be monitored by the pilot group and reviewed annually by the development group. Stakeholder involvement The initial development group, a collaboration between the Editorial independence European Headache Federation (EHF) and Lifting The Burden: The Global Campaign to Reduce the Burden of EHF was the sole funding body supporting development of Headache Worldwide, were headache specialists from these principles. Members of the development group declared Belgium, Denmark, France, Germany, Italy, Netherlands, the following possible conflicts of interest: Spain and UK. The pilot group were primary care physicians consultancy agreements with and/or research funding from from the same countries. The consultation group were mem- ACRAF SpA, Addex Pharma, Allergan, Almirall, Alpharma, bers of the National headache societies within the European Astra Zeneca, Bayer Healthcare, Berlin Chemie, Böhringer Headache Federation representing Albania, Austria, Belgium, Ingelheim, Bristol-Myers Squibb, CoLucid, Eli Lilly, Glaxo- Belarus, Bulgaria, Croatia, Denmark, Finland, France, SmithKline, Grünenthal, Helsinn Healthcare, Hoffmann La Germany, Greece, Hungary, Israel, Italy, Lithuania, Roche, Janssen-Cilag, Johnson & Johnson, Lusofarmaco, Netherlands, Poland, Portugal, Romania, Russia, Serbia and Menarini, Merck Sharpe and Dohme, 3M Medica, Novartis, Montenegro, Slovenia, Spain, Sweden, Switzerland and Pfizer, Pierre Fabré, Solvay Pharma, SanofiAventis, Sanofi- United Kingdom. Patient representatives and advocates were Synthélabo, Schaper and Brümmer, Weber & Weber. consulted through the Board of the European Headache Alliance. These principles make no recommendations that favour one proprietary medication over another with similar effects. Rigour of development References The development process was review of all treatment guide- lines in use in Europe and published or otherwise available in 1. Stovner