1 April 2004
US Headache Guidelines Consortium - Private Nonprofit Research Organization
Summary,

GUIDELINE OBJECTIVE(S)

* To evaluate inpatient treatment of headache in the United States
* To review the epidemiology and economic impact of chronic headache (CH), criteria for inpatient treatment, components of inpatient care, and outcomes of treatment, and provide a consensus statement and recommendations for further research to address the role of inpatient treatment of headache

TARGET POPULATION

Patients with chronic headache (CH)

INTERVENTIONS AND PRACTICES CONSIDERED

Inpatient Treatment/Management

1. Inpatient vs. outpatient treatment (admission criteria)
2. Intravenous dihydroergotamine (DHE)
3. Intravenous histamine
4. Treatment of withdrawal symptoms in patients with medication overuse headache
* Clonidine (opiate withdrawal)
* Phenobarbital (short-acting barbiturate withdrawal)
5. Antidopaminergic agents
6. Muscle relaxants
7. Nonopioid analgesic agents
8. Valproic acid
9. Patient education
10. Use of prophylactic medication (e.g., monoamine oxidase inhibitors, selective serotonin reuptake inhibitors)

Treatment Modalities in a Multidisciplinary Inpatient Headache Treatment Program

1. Detoxification
2. Pharmacologic therapy
3. Nursing intervention
4. Physical therapy
5. Dietary management and education
6. Stress management
7. Exercise programs
8. Biofeedback and relaxation therapy
9. Cognitive-behavioral treatment
10. Group psychotherapy
11. Individual and family psychotherapy
12. Family groups
13. Interactions between patients
14. Lifestyle management
15. Discharge planning

MAJOR OUTCOMES CONSIDERED

* Length of hospitalization
* Headache recurrence
* Patient satisfaction
* Analgesic intake
* Work absenteeism
* Work efficiency
* Pain measurement
* Frequency and duration of headache
* Number of emergency department (ED) visits
* Sleep
* Side effects of medication