Saudi clinical practice guidelines for the treatment and prevention of migraine headache

Objective: To develop clinical practice guidelines based on evidence based medicine on the use of abortive and preventive therapies for managing migraine headaches. We formulated these guidelines to offer evidence-based recommendations to improve the knowledge of physicians, healthcare professionals, and policymakers in migraine headache management.

Method: A panel of 11 experts from different sectors in Saudi Arabia approved 26 questions on abortive and preventive therapies for migraines. To develop each question, we searched “PubMed” and “Cochrane Library” databases for recent relevant systematic reviews published between 2013 and 2024. We employed the Grading Recommendations, Assessment, Development, and Evaluation methodological approach to ensure the certainty of the collated evidence and to formulate the recommendations. The expert panel voted electronically on each recommendation, and a consensus was defined as >70% agreement.

Results: We formulated a total of 26 recommendations. Of these, 14 are focused on abortive therapy for acute migraine attacks, whereas 12 are focused on the prevention of episodic or chronic migraines. These guidelines strongly recommend the use of paracetamol and ibuprofen as the first-line treatment for mild to moderate migraine. Furthermore, we concluded that propranolol should be considered as the first-line preventive intervention for migraine.

Conclusion: The Saudi clinical practice guidelines offer systematically validated recommendations of migraine headaches in adults. The recommendations are potentially beneficial for all healthcare professionals managing patients with migraine headaches.