Migraine in Primary Care Advisors

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Newsletter on the Acute Treament of Migraine

Available here:
MIPCA newsletter (Number 19 in the series) on acute treatment of migraine.

Clinical Management and Treatment of Headache Disorders in Primary Care

The department of Anaesthesia and Pain Medicine at the University of Edinburgh is developing a new, online suite of programmes focusing on the Clinical Management and Treatment of Headache Disorders in Primary Care. If you would be interested in any of the above courses, please click on the following link: http://www.anaes.med.ed.ac.uk/univ/HeadacheMedicine.html or if you require any further information then please contact Dr Chris McKenzie at cmckenz4@staffmail.ed.ac.uk

Management of Chronic Migraine

New on the MIPCA website are the outputs from a major new project ‘Management of Chronic Migraine’. MIPCA has conducted a research initiative and consultation process, to prepare information on, and guidelines for, the management of this difficult to treat and frequently controversial condition. The appropriate management of chronic migraine is pertinent to the headache-interested physician, due to the approval of Botulinum Toxin Type A (BOTOX®, Allergan) in the UK in 2010. BOTOX® is the only drug currently available for chronic migraine in the UK.

The outputs on chronic migraine cover several major topics:

• Classification and diagnosis, which has proved problematic in the past
• Epidemiology and evidence on treatments that are sometimes used by specialists
• A detailed critical evaluation of the studies with BOTOX® on chronic migraine
• Guidance on the use of BOTOX® in clinical practice
• MIPCA evidence-based guidelines for the management of chronic migraine in the clinic.

MIPCA has also prepared a statement on chronic migraine, summarising principles for its diagnosis and management. This is shown below.

MIPCA Statement on Chronic Migraine

• Chronic migraine is now recognised by the International Headache Society and defined in their classification of headache document. A sufferer has a minimum of 15 headache days per month of which a minimum of 8 days exhibit migraine features.
• The World Health Organization has ranked migraine in the 20 most disabling illnesses but it is still under-recognised, under-diagnosed and under-treated.
• It is accepted that there are a number of treatments are used in chronic migraine which are effective but not licensed. In July 2010 Botulinum Toxin Type A (BOTOX®) was licensed for chronic migraine in the UK by the Medicine and Healthcare Products Regulatory Agency (MHRA), after consideration of data that included the Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) studies. BOTOX® currently remains the only licensed drug for the condition and should be available to NHS patients. At present the National Institute for Clinical Excellence (NICE) is performing a review and it is regrettable that there is likely to be very little NHS availability of BOTOX®, at least until the NICE decision is known.
• Chronic migraine affects approximately 2.5% of the population who will seek advice from various sources: Internet, General Practitioner, Physical Therapist, etc. If these initial efforts fail to allow the patient to regain control, it is suggested that specialist intervention is optimal.
• We suggest that for a healthcare professional to offer BOTOX® for chronic migraine the minimum training requirement is to understand the impact of the condition and its differential diagnosis and management, as well as to have undertaken the specific 'BOTOX® in chronic migraine' training.

You can download the following documents from here:

1. A MIPCA newsletter (Number 18 in the series) on chronic migraine.
2. The latest MIPCA educational module (Number 8 in the series) on chronic migraine.