Migraine patients need to be better informed
The German Society for Neurology (DGN) and the German Migraine and Headache Society (DMKG) presented a new guideline for the treatment of migraines on April 26, 2018. A new core aspect is preventive measures such as medication, sports and relaxation procedures, which have been proven to be successful, but which are currently still not being sufficiently cleared up.
According to the DGN, migraine sufferers are often not adequately advised by the doctor about preventive measures against migraine attacks. The new guideline explains which preventive measures have proven to reduce the number of seizures and make them milder. The new guideline is freely accessible on the DGN website.
Migraineurs are not adequately cared for in Germany
"The treatment options are currently not being exhausted in all patients," reports Professor Hans-Christoph Diener, headache expert at DGN in a press release on the publication of the guideline. With the guideline, the DGN wants to improve the care situation for children and adults with migraines. Here doctors and patients will find a comprehensive overview of the current state of knowledge.
What helps with migraines and what doesn't?
The guideline comprises almost 100 pages and is intended to serve as a reference work on acute and preventive measures against migraines. It provides comprehensive information on how effective the respective drug, non-drug and interventional procedures are. Comments are also given on special situations such as migraines during pregnancy.
According to the DGN, migraines are the most common neurological disease in Germany. About eight to ten percent of men and ten to 25 percent of all women are affected. According to a "Global Burden of Disease" survey, a migraine disease can have a huge impact on the lives of those affected. In terms of frequency, this headache disorder ranks first among all neurological diseases in people between the ages of 15 and 49 years.
Prophylaxis options are hardly exhausted
The DGN reports on a current representative survey of the DMKG, which shows that the prophylaxis options are hardly exhausted. Less than half (43 percent) of migraine sufferers would be given advice on preventive measures by their family doctor or internist. Even with specialists, only 57 percent of those seeking help would receive the relevant information.
Only every fifth person is given prophylaxis
"Only 22 percent of migraine sufferers who could benefit from prophylaxis also receive preventive medication or measures," explains Dr. Charly Gaul, general secretary and press spokesman for the DMKG, who contributed to the guideline. Many patients are not even aware that non-medicinal measures can be used in migraine treatment.
For general practitioners, specialists, pain therapists and those affected
"The new migraine guideline is a further development of six German and international guidelines and is currently the most current guideline for migraine treatment," summarizes Professor Diener. The recommendations are just as relevant for general practitioners and internists as for neurologists, neurologists and pain therapists. Even non-medical professionals and those affected by migraines can freely access the guidelines.
New drug recommendations for migraines
The guideline contains recommendations for all medications that are currently suitable for acute therapy and prophylaxis. A new recommendation is the use of the drugs topiramate and onabotulinum toxin A for chronic migraines. It is also new that in migraine prophylaxis in children, given the very high placebo rate, no therapeutic superiority of valproic acid, topiramate or amitriptyline could be shown. The triptans are still the most effective for the acute treatment of migraine attacks.
Medicines for migraine prophylaxis
"The effectiveness of the beta blockers metoprolol and propranolol, the calcium antagonist flunarizine, the anticonvulsants topiramate and valproic acid and the tricyclic antidepressant amitriptyline are best proven in migraine prophylaxis by randomized studies," writes the DGN. In addition to drug treatment, non-drug therapies also receive more attention.
Higher priority for non-drug treatments
"Regular endurance sports help prevent migraine attacks," adds Professor Peter Kropp, director of the Institute for Medical Psychology and Medical Sociology at the University of Rostock. Relaxation methods and measures to reduce stress had also proven to be effective in prophylaxis. The non-drug procedures from behavior therapy are so effective that they can be used as an alternative to drug prophylaxis, says Kropp.
In addition to the recommendations of the DNG, some migraineurs swear by tried and true home remedies for migraines. (vb)