Classification and Clinical Features of Headache Disorders
From：Taipei World Trade Center Liaison Office in Chennai
‘Headache is one of the most common neurological disorders encountered by clinicians.1 According to the World Health Organization (WHO), headaches are among the five most common clinical disorders worldwide. Evidence suggests that active headaches affect more than 46% of the global population, and the lifetime prevalence of headache is more than 90%. Higher prevalence of headaches is reportedly associated with greater social, economic, and family burden.
Traditional Chinese Medicine (TCM) has a long history in treating headache disorders. Many treatments, such as herbal TCM treatments and physical TCM therapy, are effective in treating headaches and have therefore been the focus of studies in modern medicine. Several clinical practice guidelines (CPGs) for treating headache with TCM have been developed. Many studies have suggested that CPGs can improve clinical practice and reduce healthcare costs, but several different CPGs may be published on the same topic. If these guidelines are conflicting, this may affect the confidence of clinicians. To our knowledge, no critical appraisal has been performed on the guidelines covering TCM treatment for headaches. There are various guideline assessment tools available, but the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument is the most appropriate for guideline appraisal.
This study aimed to appraise the methodological quality of guidelines for the treatment of headache produced over the last two decades, and covering interventions using TCM. We hoped to determine the acceptance level worldwide of the different interventions using TCM, and also obtain realistic efficacy data about TCM treatments. By appraising and summarizing the current CPGs for TCM headache treatment, we can determine whether a further guideline for the treatment of headache with TCM is needed.
We searched for guidelines on headache disorders in PubMed, EMBASE, Web of Science, and four Chinese academic electronic databases, the Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure Database (CNKI), China Science and Technology Journal Database (VIP), and Wanfang database. We also searched two international guideline databases, the Guideline International Network (GIN) and National Guideline Clearinghouse (NGC), as well as a Chinese guideline database (Medlive). We used “headache” as a search term on the websites of several well-known organizations concerned with guideline development: World Health Organization (WHO), American Academy of Neurology (AAN), National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), and European Academy of Neurology (EAN). We carried out a manual search for gray literature to supplement the electronic searches. The date of publication was restricted to between January 1996 and June 5, 2015. The terms “headache”, “headache disorders”, “cephalalgia”, “migraine”, “tension-type headache”, “practice guideline”, “consensus”, “statement”, “regulation”, and “recommendation” were used in both the “MeSH” and “Free-text” fields. We searched Chinese guidelines for headache disorders manually, as these were published in books and government documents.
Inclusion and exclusion criteria
We included all Chinese and English language CPGs that provided recommendations on the diagnosis, treatment, and management of headache disorders, and met the definition of guidelines, as described by the Institute of Medicine.
Guidelines were excluded if they met any of the following criteria: (a) did not include TCM therapies for headaches, including both herbal (Chinese herbal formulas, Chinese patent medicine, and herbal extracts) and physical TCM therapies (acupuncture, moxibustion, massage, manipulation, and osteopathy); (b) translations of international guidelines into Chinese, adaptations of international guidelines for China, abstracts or summary reports of international guidelines, and other explanatory or evaluation reports of guidelines; and (c) beta versions or older versions of guidelines from the same source.
Literature screening and review data extraction
Using the inclusion and exclusion criteria, all records were classified using Endnote (Version X7, Thomson Reuters, USA), and duplicate studies were discarded. Next, two of the authors (Luo Hao and Yao Sha) independently screened all the search records by browsing the title and abstract using the predefined inclusion and exclusion criteria. We then obtained the full text of possible guidelines to determine whether they were eligible, and extracted the general characteristics of each CPG included. Disagreements were resolved by consensus between the two authors or by a third expert (Li Hui).’
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