review · Cephalalgia
Clinical guidelines for the pharmacological treatment of migraine provide actionable recommendations for healthcare professionals. Jointly created by the Italian Society for the Study of Headache and the International Headache Society, the recommendations integrate evidence from randomised controlled trials alongside expert opinion. The guidelines were developed through a systematic literature review following Cochrane methods across several databases, evaluating evidence quality using the Grading of Recommendations, Assessment, Development and Evaluation approach. Beyond synthesising current clinical evidence to standardise migraine management and promote high-quality care across diverse healthcare environments, the work identifies significant gaps in existing medical knowledge. In particular, it notes a distinct lack of direct head-to-head comparisons between different medications and underlines the ongoing requirement for studies evaluating long-term treatment outcomes.
Migraine is a widespread neurological condition, yet treatment approaches can vary substantially across clinical settings. By standardising pharmacological management using rigorous systematic evidence and expert consensus, these guidelines help clinicians deliver consistent, high-quality care. They also highlight pressing knowledge gaps, showing where future clinical research must focus to improve patient outcomes.
These guidelines are directly applicable to clinical practice, offering healthcare professionals ready-to-use protocols to standardise migraine prescribing. For pharmaceutical developers and clinical research organisations, the identified gaps highlight clear commercial and research opportunities, specifically regarding the design of head-to-head comparative drug trials and long-term therapeutic outcome studies. The recommendations represent an immediately usable standard for care delivery and trial benchmarking.
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We here present evidence-based guidelines for the pharmacological treatment of migraine. These guidelines, created by the Italian Society for the Study of Headache and the International Headache Society, aim to offer clear, actionable recommendations to healthcare professionals. They incorporate evidence-based recommendations from randomized controlled trials and expert-based opinions. The guidelines follow the Grading of Recommendations, Assessment, Development and Evaluation approach for assessing the quality of evidence. The guideline development involved a systematic review of literature across multiple databases, adherence to Cochrane review methods, and a structured framework for data extraction and interpretation. Although the guidelines provide a robust foundation for migraine treatment, they also highlight gaps in current research, such as the paucity of head-to-head drug comparisons and the need for long-term outcome studies. These guidelines serve as a resource to standardize migraine treatment and promote high-quality care across different healthcare settings.
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DOI: 10.1177/03331024241305381
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