Clinical Practice Guideline for Chronic Headache 2013

Table of Contents

On Publication of the Clinical Practice Guideline for Chronic Headache 2013

On publication of the English edition of the guideline

Lists of members of Chronic Headache Clinical Practice Guideline Development Committee, members of Evaluation and Coordination Committee, collaborating societies

I. Headache: General ConsiderationsPDF

CQ I-1 How is headache classified and diagnosed?

CQ I-2 How are primary headaches and secondary headaches differentiated?

CQ I-3 How is subarachnoid hemorrhage diagnosed?

CQ I-4 What are the procedures for managing headache in the emergency room?

CQ 1-5 How should primary care physicians manage headache?

CQ I-6 How should dentists manage headache?

CQ I-7 Are headache clinic and headache specialist necessary? Is collaborative care useful for primary headaches?

CQ I-8 How are algorithms used?

CQ I-9 How is the impact of headache on individuals measured?

CQ 1-10 How are questionnaires and screeners used?

CQ I-11 How is the headache diary used?

CQ I-12 What types of primary headaches require treatment?

CQ I-13 What types of primary headache require hospitalized treatment and what are the treatment methods?

CQ I-14 How is pharmacotherapy using over-the-counter medications planned?

CQ I-15 Are herbal medicines (Kampo) effective?

CQ I-16 What other therapies are available, apart from pharmacotherapy?

CQ I-17 Is cognitive-behavioral therapy effective for primary headaches?

CQ I-18 Does anxiety/depression coexist with primary headaches?

CQ I-19 How should occupational health physicians and brain health check-up physicians manage headache?

CQ I-20 How should school physicians manage headache?

CQ I-21 What are the important points in patient education and doctor‒patient relationship?

CQ I-22 How to evaluate the medico-economic effect of appropriate treatment for migraine?

CQ I-23 Is there a need for multidisciplinary team approach to headache treatment?

CQ I-24 How is headache or facial or neck pain attributed to cervical carotid or vertebral artery dissection diagnosed?

CQ I-25 How is headache attributed to spontaneous intracranial hypotension diagnosed and treated?

II. Migraine

1. Diagnosis • Epidemiology • Pathophysiology • Precipitating factors • PrognosisPDF

CQ II-1-1 How is migraine classified?

CQ II-1-2 How is migraine diagnosed?

CQ II-1-3 What is the prevalence of migraine in Japan?

CQ II-1-4-1 What hypotheses have been proposed for the pathophysiology of migraine?

CQ II-1-4-2 What are the types of auras in migraine?

CQ II-1-4-3 What is the proposed mechanism for aura in migraine?

CQ II-1-4-4 What is the proposed mechanism for pain in migraine?

CQ II-1-4-5 How is migraine related to serotonin abnormality?

CQ II-1-4-6 How does cerebral blood flow change during migraine attack?

CQ II-1-5 What are the precipitating/aggravating factors of migraine?

CQ II-1-6-1 What is the prognosis of migraine (including chronification of migraine)?

CQ II-1-6-2 To what extent does migraine impair the healthy life expectancy and QOL of patients?

CQ II-1-7 What are the comorbid disorders associated with migraine?

CQ II-1-8 What kind of disease is chronic migraine?

CQ II-1-9 Is migraine a risk factor of cerebral infarction?

CQ II-1-10 Is it safe for migraine patients to use low-dose oral contraceptives?

2. Acute TreatmentPDF

CQ II-2-1 What are the acute treatments for migraine and how are they used?

CQ II-2-2 What is the timing of taking triptans?

CQ II-2-3 How should patient preference for multiple triptans be determined?

CQ II-2-4 When and how are non-oral formulations of triptans used for the treatment of migraine?

CQ II-2-5 How should the acute phase of migraine with brainstem aura and hemiplegic migraine be managed?

CQ II-2-6 How are ergotamines used?

CQ II-2-7 Are acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) effective acute treatments for migraine?

CQ II-2-8 Are antiemetics useful acute treatment for migraine?

CQ II-2-9 What other acute treatment drugs for migraine are available?

CQ II-2-10 What are the acute treatments for severe migraine attacks and status migrainosus?

CQ II-2-11 How should migraine be treated (acute and prophylactic) during pregnancy and breast-feeding?

CQ II-2-12 The diagnosis and treatment of menstrual migraine

3. Prophylactic therapyPDF

CQ II-3-1 What kinds of patients requires prophylactic therapy?

CQ II-3-2 What kinds of drugs are available for prophylactic therapy?

CQ II-3-3 How should multiple prophylactic therapies be used differentially?

CQ II-3-4 How long should prophylactic therapy be continued?

CQ II-3-5 Are beta-blockers (propranolol) effective for migraine prevention?

CQ II-3-6 Are calcium channel blockers (lomerizine) effective for migraine prevention?

CQ II-3-7 Are angiotensin-converting enzyme (ACE) inhibitors and angiotensin II blockers (ARB) effective for migraine prevention?

CQ II-3-8 Are antiepileptic drugs (valproic acid) effective for migraine prevention?

CQ II-3-9-1 Are antidepressants effective for migraine prevention?

CQ II-3-9-2 Is combined use of antidepressants (SSRI/SNRI) and triptan safe?

CQ II-3-10 Are magnesium, vitamin B12, feverfew, and analgesics effective for migraine prevention?

CQ II-3-11 Are other prophylactic therapies effective for migraine prevention?

CQ II-3-12 Is botulinum neurotoxin (BoNT) effective for migraine prevention?

CQ II-3-13 How is typical aura without headache diagnosed and treated?

CQ II-3-14 How should chronic migraine be treated?

III. Tension-type headachePDF

CQ III-1 How is tension-type headache classified?

CQ III-2 How is tension-type headache diagnosed?

CQ III-3 How big is the population of tension-type headache patients? What are the risk factors, triggers, and prognosis? What is the real prevalence of tension-type headache?

CQ III-4 What is the proposed pathophysiology for tension-type headache?

CQ III-5 What is the relationship between transformed migraine and tension-type headache?

CQ III-6 How is tension-type headache treated?

CQ III-7 What kinds of acute treatment (during headache, abortive) are available for tension-type headache? How effective are they? How should these drugs be used differentially?

CQ III-8 How should prophylactic therapy for tension-type headache be conducted?

CQ III-9 Apart from pharmacotherapy, what other therapies are used for tension-type headache?

CQ III-10 Is botulinum toxin effective for tension-type headache?

IV. Trigeminal autonomic cephalalgiasPDF

CQ IV-1 How are trigeminal autonomic cephalalgias classified and typed?

CQ IV-2 How are trigeminal autonomic cephalalgias diagnosed?

CQ IV-3 How big is the population of patients with trigeminal autonomic cephalalgias? What are the risk factors and aggravating factors? What is the prognosis?

CQ IV-4 What is the proposed pathophysiology for trigeminal autonomic cephalalgias?

CQ IV-5 What kinds of acute treatments are available for cluster headache, and how effective are they?

CQ IV-6 What kinds of medications for prophylactic therapy are available for cluster headache, and how effective are they?

CQ IV-7 What kinds of medications are available for the treatment of paroxysmal hemicrania, and how effective are they?

CQ IV-8 What kinds of medications are available for the treatment of SUNCT and SUNA, and how effective are they?

CQ IV-9 How do trigeminal autonomic cephalalgias impact the patients’ heathy life expectancy and QOL?

V. Other primary headache disordersPDF

CQ V-1 Apart from migraine, tension-type headache and cluster headache, what are the other types of primary headache disorders?

CQ V-2 How are primary stabbing headache, primary cough headache, and primary exercise headache diagnosed and treated?

CQ V-3 How is primary headache associated with sexual activity diagnosed and treated?

CQ V-4 How is hypnic headache diagnosed and treated?

CQ V-5 How is primary thunderclap headache diagnosed and treated?

CQ V-6 How is hemicrania continua diagnosed and treated?

CQ V-7 How is new daily persistent headache diagnosed and treated?

CQ V-8 How is chronic daily headache diagnosed?

VI. Medication-overuse headachePDF

CQ VI-1 How is medication-overuse headache diagnosed?

CQ VI-2 How big is the population of medication-overuse headache patients?

CQ VI-3 What are the treatment methods and prognosis of medication-overuse headache?

VII. Headaches in ChildrenPDF

CQ VII-1 What types of headache are common in children?

CQ VII-2 How is migraine in children diagnosed?

CQ VII-3 What types of secondary headache are common in children?

CQ VII-4 What kinds of acute and prophylactic medications are available for the treatment of migraine in children, and how effective are they?

CQ VII-5 What is the prevalence of chronic daily headache in children, and how is the headache diagnosed and treated?

VIII. GeneticsPDF

CQ VIII-1 Are there genetic factors associated with migraine?

CQ VIII-2 Are there genetic factors associated with cluster headache?

CQ VIII-3 Are there genetic factors associated with tension-type headache?

CQ VIII-4 Does familial (hereditary) migraine caused by single gene mutations exist?

CQ VIII-5 Is genetic diagnosis for migraine possible?

Appendix I Guideline for Self-injection of Sumatriptan at HomePDF

CQ 1 What kinds of patients receive treatment by self-injection of sumatriptan at home (indication, adverse effects, contraindications)?

CQ 2 How should self-injection of sumatriptan at home be initiated and explained to the patient? What is the appropriate amount to be prescribed?

CQ 3 What instructions should be given for the first sumatriptan self-injection at home, and what measures should be taken during emergency (when serious adverse event occurs)?

Appendix II Guideline for Migraine Treatment by Valproic Acid (Provisional Edition)PDF

CQ 1 Is valproic acid effective for migraine prevention? Is there international consensus for valproic acid as prophylactic medication for migraine?

CQ 2 What kinds of migraine patients are treated by valproic acid?

CQ 3 What doses of valproic acid are used for the treatment of migraine? What are the precautions during administration of valproic acid?

CQ 4 What is the significance of measuring blood levels of valproic acid in the treatment of migraine?

CQ 5 Is valproic acid safe and effective in preventing migraine in children?

Appendix III Guideline for Migraine Treatment by Propranolol (Provisional Edition)PDF

CQ 1 Is propranolol effective for migraine prevention? Is there international consensus for propranolol as prophylactic medication for migraine?

CQ 2 What kinds of migraine patients are treated by propranolol?

CQ 3 What doses of propranolol are used for the treatment of migraine?

CQ 4 What precautions have to be taken during administration of propranolol (adverse reactions, interactions)?

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