The 2012 AHS/AAN Guidelines for Prevention of Episodic Migraine: A Summary and Comparison With Other Recent Clinical Practice Guidelines

Authors

  • Elizabeth Loder MD, MPH,

    Corresponding author
    1. From the Graham Headache Center and the Department of Neurology, Division of Headache and Pain, Brigham and Women's and Faulkner Hospitals, Boston, MA, USA (E. Loder, R. Burch, P. Rizzoli).
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  • Rebecca Burch MD,

    1. From the Graham Headache Center and the Department of Neurology, Division of Headache and Pain, Brigham and Women's and Faulkner Hospitals, Boston, MA, USA (E. Loder, R. Burch, P. Rizzoli).
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  • Paul Rizzoli MD

    1. From the Graham Headache Center and the Department of Neurology, Division of Headache and Pain, Brigham and Women's and Faulkner Hospitals, Boston, MA, USA (E. Loder, R. Burch, P. Rizzoli).
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  • Conflict of Interest: PR and RB have no conflicts of interest relevant to this paper. EL is a member of the dissemination committee for the 2012 AHS/AAN Guidelines but was not involved in their development. She is the president-elect of the American Headache Society, which was a partner in the development of the guidelines and endorsed the completed guidelines.

  • Financial support for work: None.

E. Loder, Department of Neurology, Brigham and Women's Hospital, 1153 Centre Street, Boston, MA 02130, USA, email: eloder@partners.org

Abstract

Background.— Updated guidelines for the preventive treatment of episodic migraine have been issued by the American Headache Society (AHS) and the American Academy of Neurology (AAN). We summarize key 2012 guideline recommendations and changes from previous guidelines. We review the characteristics, methods, consistency, and quality of the AHS/AAN guidelines in comparison with recently issued guidelines from other specialty societies.

Methods.— To accomplish this, we reviewed the AHS/AAN guidelines and identified comparable recent guidelines through a systematic MEDLINE search. We extracted key data, and summarized and compared the key recommendations and assessed quality using the Appraisal of Guidelines Research and Evaluation-II (AGREE-II) tool. We identified 2 additional recent guidelines for migraine prevention from the Canadian Headache Society and the European Federation of Neurological Societies. All of the guidelines used structured methods to locate evidence and linked recommendations with assessment of the evidence, but they varied in the methods used to derive recommendations from that evidence.

Results.— Overall, the 3 guidelines were consistent in their recommendations of treatments for first-line use. All rated topiramate, divalproex/sodium valproate, propranolol, and metoprolol as having the highest level of evidence. In contrast, recommendations diverged substantially for gabapentin and feverfew. The overall quality of the guidelines ranged from 2 to 6 out of 7 on the AGREE-II tool.

Conclusion.— The AHS/AAN and Canadian guidelines are recommended for use on the basis of the AGREE-II quality assessment. Recommendations for the future development of clinical practice guidelines in migraine are provided. In particular, efforts should be made to ensure that guidelines are regularly updated and that guideline developers strive to locate and incorporate unpublished clinical trial evidence.

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