More than 0.6 million people suffer from disabling migraines in Greece causing a dramatic work loss, but only a small proportion of migraineurs attend headache centres, most of them being treated by non-experts. On behalf of the Hellenic Headache Society, we report here a consensus on the diagnosis and treatment of adult migraine that is based on the recent guidelines of the European Headache Federation, on the principles of Good Clinical Practice and on the Greek regulatory affairs. The purposes are three-fold: (1) to increase awareness for migraine in Greece; (2) to support Greek practitioners who are treating migraineurs; and (3) to help Greek migraineurs to get the most appropriate treatment. For mild migraine, symptomatic treatment with high dose simple analgesics is suggested, while for moderate to severe migraines triptans or non-steroidal anti-inflammatory drugs, or both, should be administered following an individually tailored therapeutic strategy. A rescue acute treatment option should always be advised. For episodic migraine prevention, metoprolol (50–200 mg/d), propranolol (40–240 mg/d), flunarizine (5–10 mg/d), valproate (500–1800 mg/d), topiramate (25–100 mg/d) and candesartan (16–32 mg/d) are the drugs of first choice. For chronic migraine prevention topiramate (100-200 mg/d), valproate (500–1800 mg/d), flunarizine (5–10 mg/d) and venlafaxine (150 mg/d) may be used, but the evidence is very limited. Botulinum toxin type A and monoclonal antibodies targeting the CGRP pathway (anti-CGRP mAbs) are recommended for patients suffering from chronic migraine (with or without medication overuse) who failed or did not tolerate two previous treatments. Anti-CGRP mAbs are also suggested for patients suffering from high frequency episodic migraine (≥8 migraine days per month and less than 14) who failed or did not tolerate two previous treatments.

中文翻译：

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希腊头痛学会偏头痛诊治共识

在希腊，有超过 60 万人患有致残性偏头痛，导致严重失业，但只有一小部分偏头痛患者就诊于头痛中心，其中大多数是由非专家治疗的。我们代表希腊头痛协会在此报告关于成人偏头痛诊断和治疗的共识，该共识基于欧洲头痛联合会最近的指南、良好临床实践的原则和希腊监管事务。目的有三个：（1）提高希腊对偏头痛的认识；(2) 支持治疗偏头痛的希腊医生；(3) 帮助希腊偏头痛患者获得最合适的治疗。对于轻度偏头痛，建议使用大剂量单纯镇痛药对症治疗，而对于中度至重度偏头痛，曲坦类药物或非甾体类抗炎药，或两者兼而有之，则应遵循个体化的治疗策略。应始终建议采用抢救性急性治疗方案。预防发作性偏头痛，美托洛尔（50–200 mg/d）、普萘洛尔（40–240 mg/d）、氟桂利嗪（5–10 mg/d）、丙戊酸盐（500–1800 mg/d）、托吡酯（25–100 mg/d) 和坎地沙坦 (16-32 mg/d) 是首选药物。对于慢性偏头痛预防，可以使用托吡酯（100-200 mg/d）、丙戊酸盐（500-1800 mg/d）、氟桂利嗪（5-10 mg/d）和文拉法辛（150 mg/d），但证据非常充分有限的。A 型肉毒杆菌毒素和针对 CGRP 通路的单克隆抗体（抗 CGRP 单克隆抗体）推荐用于慢性偏头痛（有或没有药物过度使用）的患者，这些患者之前的两次治疗失败或不能耐受。抗 CGRP mAb 也适用于患有高频发作性偏头痛（每月 ≥ 8 天且少于 14 天）且之前两次治疗失败或不能耐受的患者。