Drug- and caffeine-induced headaches
CMAJ 1997;157:510
Re: "Guidelines for the diagnosis and management of migraine in clinical practice" (CMAJ 1997;156:1273-87 [full text / résumé]), by Dr. William E.M. Pryse-Phillips and associates
In response to: P.E. Shea
I certainly agree with Dr. Shea that there are several areas to do with migraine that require emphasis for their optimal management in Canada.
Our article was written according to the strict requirements for guidelines based on randomized controlled trials. Very few of the nonpharmacologic therapies have been subject to such analyses; as a result, they could not be included. As we mentioned in the article, we have decided to perform a separate review of all such therapies, including acupuncture, biofeedback and hypnosis.
The whole problem of drug-induced headache is a very important one. We referred to it briefly in our article but, to my knowledge, no firm guidelines for diagnosis have yet been constructed and agreed upon, although this work is in progress.
William Pryse-Phillips, MD
Memorial University of Newfoundland
Health Sciences Centre
St. John's, Nfld.
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