Principles of Management

Interventional programmes, especially in primary care (Campaign objective 3), must provide guidance on management. Most countries of the world have none. Cornerstone principles of treatment are more feasible than guidelines.

Lifting The Burden has collaborated with a working group of the European Headache Federation to produce evidence- and consensus-based European principles of management of the headache disorders important in primary care. This was done by harmonizing existing national guidelines.

The European principles of management are currently being updated. Later, they will be adapted for other regions, again harmonizing with national guidelines where these exist.

Click here to view the pdf file European principles of management of common headache disorders in primary care.

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Essential medicines


Lifting The Burden is collecting and submitting evidence to WHO on medicines that should and should not be included in their list of essential medicines. This list has political weight and is persuasive to national health policy-makers.

The list of essential medicines has the subject heading "Migraine", but other headache disorders are not currently represented.

For acute migraine, ergotamine was deleted in the 2005 review, leaving only acetylsalicylic acid and paracetamol. On Lifting The Burden's recommendation, ibuprofen was added for children. Adding a triptan would increase availability of and access to at least one triptan in many countries worldwide, with considerable potential for improving care.

Propranolol is the only drug listed for migraine prophylaxis.

Lifting The Burden will develop arguments for adding a triptan, including other migraine prophylactic drugs, and for broadening the scope of the list of essential medicines to include tension-type headache, which is more prevalent than migraine.

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To improve the evidence base for all headache treatments, Lifting The Burden for several years supported, both financially and intellectually, the headache sub-group within the Pain, Palliative and Supportive Care (PaPaS) Group of the Cochrane Collaboration.


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