Clinical Practice Guideline for Headache Disorders 2021

ABSTRACT The International Headache Society published the International Classification of Headache Disorders, 3rd edition in 2018. In this classification, Chapter 3—previously “Cluster headache and other trigeminal‐autonomic cephalalgias”—was renamed “Trigeminal‐autonomic cephalalgias (TACs).” Trigeminal‐autonomic cephalalgias are a group of disorders characterized by unilateral severe headache and cranial autonomic symptoms, with cluster headache as a representative condition. Several major revisions have also been made regarding the diagnostic criteria for trigeminal‐autonomic cephalalgias in terms of ictal symptomatology and the duration of remission period. Moreover, calcitonin gene‐related peptide‐targeting treatments have enabled significant improvements in migraine management to be made. In Japan, in response to these advances in headache medicine, the Clinical Practice Guideline for Headache Disorders was revised by the Study Group for Headache Clinical Practice Guideline Development. The new guidelines include the latest information and present global standards of management for both primary and secondary headache disorders in consideration of local labelling and regulatory approvals. The guideline comprises eight chapters: “I. Headache: general considerations,” “II. Migraine,” “III. Tension‐type headache,” “IV. Trigeminal‐autonomic cephalalgias,” “V. Other primary headache disorders,” “VI. Medication‐overuse headache (MOH),” “VII. Headaches in children,” and “VIII. Secondary headaches.” The GRADE system was adopted to address the clinical question “Are triptans more useful than nonsteroidal anti‐inflammatory drugs as acute treatment for migraines?” This paper was prepared to present the core treatment recommendations for primary headache disorders and medication‐overuse headache in English.