Migraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.

BackgroundResting-state functional connectivity (FC) MRI has widely been used to understand migraine pathophysiology and to identify an imaging marker of the disorder. Here, we review what we have learned from FC studies.MethodsWe performed a literature search on the PubMed website for original articles reporting data obtained from conventional resting-state FC recording in migraine patients compared with healthy controls or during and outside of migraine attacks in the same patients.ResultsWe found 219 articles and included 28 in this review after screening for inclusion and exclusion criteria. Twenty-five studies compared migraine patients with healthy controls, whereas three studies investigated migraine patients during and outside of attacks. In the studies of interictal migraine more alterations of more than 20 FC networks (including amygdala, caudate nucleus, central executive, cerebellum, cuneus, dorsal attention network, default mode, executive control, fronto-parietal, hypothalamus, insula, neostriatum, nucleus accumbens, occipital lobe, periaqueductal grey, prefrontal cortex, salience, somatosensory cortex I, thalamus and visual) were reported. We found a poor level of reproducibility and no migraine specific pattern across these studies.ConclusionBased on the findings in the present review, it seems very difficult to extract knowledge of migraine pathophysiology or to identify a biomarker of migraine. There is an unmet need of guidelines for resting-state FC studies in migraine, which promote the use of homogenous terminology, public availability of protocol and the a priori hypothesis in line with for instance randomized clinical trial guidelines.

К л и н и ч е с к и е р е к о м е н д а ц и и Ассоциация ревматологов России, Российское общество по изучению боли, Российская гастроэнтерологическая ассоциация, Российское научное медицинское общество терапевтов, Ассоциация травматологов-ортопедов России, Российская ассоциация паллиативной медицины РАЦИОНАЛЬНОЕ ИСПОЛЬЗОВАНИЕ НЕСТЕРОИДНЫХ ПРОТИВОВОСПАЛИТЕЛЬНЫХ ПРЕПАРАТОВ. Клинические рекомендации КОЛЛЕКТИВ АВТОРОВ Каратеев Андрей Евгеньевич-заведующий лабораторией патофизиологии боли и полиморфизма скелетно-мышечных заболеваний ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» 1 , докт. мед. наук Насонов Евгений Львович-научный руководитель ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» 1 , заведующий кафедрой ревматологии ИПО ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский университет) 2 , президент Ассоциации ревматологов России, академик РАН, профессор, докт. мед. наук Ивашкин Владимир Трофимович-заведующий кафедрой пропедевтики внутренних болезней лечебного факультета, директор Клиники пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский университет) 2 , главный внештатный специалист гастроэнтеролог Минздрава России, президент Российской гастроэнтерологической ассоциации, академик РАН, докт. мед. наук, профессор Мартынов Анатолий Иванович-профессор кафедры госпитальной терапии №1 лечебного факультета ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России 3 , академик РАН, докт. мед. наук, профессор Яхно Николай Николаевич-профессор кафедры нервных болезней лечебного факультета, директор научно-образовательного клинического центра неврологии ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский университет) 2 , президент Российского общества по изучению боли, академик РАН, докт. мед. наук, профессор Арутюнов Григорий Павлович-заведующий кафедрой пропедевтики внутренних болезней и лучевой диагностики ФГБОУ ВО «Российский научно-исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России 4 , главный внештатный специалист терапевт Департамента здравоохранения г. Москвы, член-корреспондент РАН, докт. мед. наук, профессор Алексеева Людмила Ивановна-заведующая отделом метаболических заболеваний костей и суставов с центром профилактики остеопороза Минздрава России ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» 1 , докт. мед. наук, профессор Абузарова Гузель Рафаиловна-руководитель центра паллиативной помощи онкологическим больным Московского научно-исследовательского онкологического института им. П.А. Герцена-филиала ФГБУ «Национальный медицинский исследовательский радиологический центр» Минздрава России 5 , докт. мед. наук Евсеев Максим Александрович-научный руководитель по хирургии ФГБУ «К...

BackgroundThe study was a collaboration between Lifting The Burden (LTB) and the European Headache Federation (EHF). Its aim was to evaluate the implementation of quality indicators for headache care Europe-wide in specialist headache centres (level-3 according to the EHF/LTB standard).MethodsEmploying previously-developed instruments in 14 such centres, we made enquiries, in each, of health-care providers (doctors, nurses, psychologists, physiotherapists) and 50 patients, and analysed the medical records of 50 other patients. Enquiries were in 9 domains: diagnostic accuracy, individualized management, referral pathways, patient’s education and reassurance, convenience and comfort, patient’s satisfaction, equity and efficiency of the headache care, outcome assessment and safety.ResultsOur study showed that highly experienced headache centres treated their patients in general very well. The centres were content with their work and their patients were content with their treatment. Including disability and quality-of-life evaluations in clinical assessments, and protocols regarding safety, proved problematic: better standards for these are needed. Some centres had problems with follow-up: many specialised centres operated in one-touch systems, without possibility of controlling long-term management or the success of treatments dependent on this.ConclusionsThis first Europe-wide quality study showed that the quality indicators were workable in specialist care. They demonstrated common trends, producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1 and 2).Electronic supplementary materialThe online version of this article (doi:10.1186/s10194-016-0707-9) contains supplementary material, which is available to authorized users.

Background Migraine is a prevalent and disabling headache disorder that affects more than 1.04 billion individuals world-wide. It can result in reduction in quality of life, increased disability, and high socio-economic burden. Nevertheless, and despite the availability of evidence-based national and international guidelines, the management of migraine patients often remains suboptimal, especially for chronic migraine (CM) patients. Methods My-LIFE anamnesis project surveyed 201 General practitioners (GPs) from 5 European countries (France, Germany, Italy, Spain, and the UK) with the aim of understanding chronic migraine (CM) patients’ management in the primary care setting. Results In our survey, GPs diagnosed episodic migraine (EM) more often than CM (87% vs 61%, p < 0.001). We found that many CM patients were not properly managed or referred to specialists, in contrast to guidelines recommendations. The main tools used by primary-care physicians included clinical interview, anamnesis guide, and patient diary. Tools used at the first visit differed from those used at follow-up visits. Up to 82% of GPs reported being responsible for management of patients diagnosed with disabling or CM and did not refer them to a specialist. Even when the GP had reported referring CM patients to a specialist, 97% of them were responsible for their follow-up. Moreover, the treatment prescribed, both acute and preventive, was not in accordance with local and international recommendations. GPs reported that they evaluated the efficacy of the treatment prescribed mainly through patient perception, and the frequency of follow-up visits was not clearly established in the primary care setting. These results suggest that CM is underdiagnosed and undertreated; thereby its management is suboptimal in the primary care. Conclusions There is a need of guidance in the primary care setting to both leverage the management of CM patients and earlier referral to specialists, when appropriate.