1 September 2007
National Committee on Neuroscience (Singapore) - National Government Agency [Non-U.S.]
National Medical Research Council (Singapore Ministry of Health) - National Government Agency [Non-U.S.]
Singapore Ministry of Health - National Government Agency [Non-U.S.]
Summary,

GUIDELINE OBJECTIVE(S)

* To update the 2000 national guidelines on headache
* To raise awareness of the different forms of headaches and the importance of making a correct diagnosis
* To discuss the mainstay treatment for the various headaches as well as alternative treatments and to highlight the dangers of medication overuse headaches

TARGET POPULATION

Patients with various types of headaches, such as migraine, tension type headaches, and medication overuse headaches

These guidelines are not intended for patients with intractable headaches.

INTERVENTIONS AND PRACTICES CONSIDERED

Diagnosis and Evaluation

1. Use of International Headache Society criteria for diagnosis and classification
2. Diagnosis of migraine using a validated 3-item questionnaire (ID-Migraine)
3. Assessment of disability using a standardized self-assessment questionnaires (The Migraine Disability Assessment [MIDAS] and the Headache Impact Test Questionnaire [HIT-6])
4. Evaluation of the psychiatric and psychological aspects of migraines and tension headaches
5. Neuroimaging

Note: Guideline developers considered but did not recommend skull x-rays and lumbar punctures for evaluation of headaches.

Management, Treatment, and/or Prevention

Pharmacological Treatment (see "Major Recommendations" for context)

1. Simple analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs)
2. Caffeine as analgesic adjuvant
3. Antiemetics
4. Nonselective 5-hydroytryptamine receptor agonists
5. Selective 5-hydroxytryptamine receptor agonists
6. Beta-blockers
7. Calcium channel blockers
8. Serotonin receptor antagonists
9. Antidepressants
10. Anticonvulsants
11. Angiotensin blockers
12. Other agents (feverfew, magnesium, riboflavin, coenzyme Q10, botulinum toxin A, butterbur)

Non-pharmacologic Measures

1. Avoidance of medication overuse
2. Patient education
3. Biofeedback, relaxation training, and physical therapy for migraine in pregnancy
4. Adjunctive psychological interventions, such as cognitive behavioral therapy or stress management therapy
5. Referral of patients with suspected secondary headaches
6. Acupuncture for prophylactic treatment of migraine and tension-type headache

MAJOR OUTCOMES CONSIDERED

* Effectiveness of measures used to prevent and/or treat headaches (headache frequency, severity, and duration; functioning, disability)
* Quality of life
* Scores on standardized questionnaires, such as the Migraine Disability Assessment Questionnaire (MIDAS) and the Headache Impact Test Questionnaire (HIT-6)
* Adverse effects, risks, safety, and benefits of medication