Ten years after the publication of the first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults, the Guideline Committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update the therapeutic guidelines and, at the same time, to also include, updated guidelines for tension-type headache, which were published, in Italian, in 1998. Therapeutic approaches for trigeminal-autonomic cephalgias (TACs) and other primary headaches were also included. For the latter, the articles available in the literature did not permit an adeguate definition of the levels of evidence and scientific strength of evidence and thus, for many drugs the alternative fell on clinical judgment. Compared to the previous edition, particular conditions, such as, pregnancy and lactation, old age, management of primary forms in the Emergency Department were also taken into consideration. As in the previous edition, headache in juveniles was not considered and will be dealt with in a separate document. This version synthetically reports only the treatment aspects, referring to the International Headache Society classification (ICHD-II, 2004) for diagnostic criteria and its Appendix for some nosographic entities not yet recognized, such as, menstrual migraine. A literature search was performed considering all the articles published from 2001 to 2010. Levels of evidence, scientific strength of evidence, clinical effectiveness, adverse events and levels of recommendation according to the criteria used in the previous publication were defined for each drug.
The update also concerns non-pharmacological treatment which in the past decade has been improved with new techniques that offer promising options reserved particularly for the forms refractory to drug treatment. The Committee was formed with a multidisciplinary view since the principal users of the guidelines are headache specialists from various disciplines. As in the previous guidelines, a few headache patients were invited to take part in the Committee and give their opinion on the therapeutic pathways contributing, in an incisive manner, with the definition of levels of recommendation. The differences with other guidelines concerns various aspects and some recommendations reflect the differences in approach and in management of headache treatment which characterize individual countries.
The recommendation on which all agree is to avoid the overuse of symptomatic drugs, particularly those in association or containing opioids or barbiturates that may contribute to the chronicity of headache.