Resumo

MUNOZ, Joe et al. Expert consensus on the preventive and acute treatment of migraine on behalf of the Colombian Association of Neurology. Acta Neurol Colomb. [online]. 2014, vol.30, n.3, pp.175-185. ISSN 0120-8748.

Introduction: Migraine is the primary headache with the highest impact in the general population. According to local information, about 3 million people in Colombia suffer from this neurological condition leading to high burden and disability. Objective: To provide uniform information regarding the acute and preventive treatment of patients with migraine. Information about chronic migraine, medication overuse was considered. Materials and methods: Expert consensus by using online Delphi methodology. Three rounds were carried out, the whole group participated in two of them and the developer group in the total number of rounds. A review of the literature was conducted to obtain academic support to design questions with clinical relevance. Neurologists from the main Colombian regions were included. Results: Preventive treatment should be offered to patients with more than 6 headache days for 6 to 12 months according to individual clinical features. Topiramate, Divalproex sodium/Valproic acid, metoprolol, propranolol, amytriptiline and flunzarizine are indicated for the first line therapy. With regard to acute treatment for out-patients the expert consensus recommends oral and subcutaneous triptans, oral anti-inflammatory non-steroidal drugs (NSAIDs), anti-emetics, combined medications, and ergot derivates. For in-patients the panel recommends metoclopramide, dexamethasone and parenteral NSAIDs. For patients with chronic migraine onabotulinum toxin Type A, topiramate, divalproate sodium/Valproic acid and amytriptiline are considered the medications of choice for this complication of migraine. In cases of medication over use associated to chronic migraine, stopping the overused substance is indicated, prescribing corticosteroids, NSAIDs and long acting triptans as bridge therapy. Occipital nerve stimulation is a second line alternative for specific refractory patients and must be chosen by an interdisciplinary team led by a neurologist specialized in diagnosis and treatment of headache patients. Conclusions: Main recomendations and suggestions regarding acute and preventive treatment on migraine were obtained. Recomendations with respect to refractory cases and medications overuse headache are shown.

Palavras-chave : Migraine; consensus; Delphi; preventive; acute treatment.

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