European Headache Federation recommendations for neurologists managing giant cell arteritis
EHF · 2020 · Europe
Source and licence
- Authors
- S P Mollan, K Paemeleire, J Versijpt et al.
- Title
- European Headache Federation recommendations for neurologists managing giant cell arteritis
- Journal
- The Journal of Headache and Pain, 2020
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC7079499
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Recommendation
- To reduce diagnostic delay, improve likelihood for securing diagnosis and improve patient outcomes, patients with suspected GCA should be referred to a rapid access specialist GCA service where available.
- Where ophthalmic symptoms are present, emergency referral to an ophthalmologist should be sought to confirm the nature of the visual symptoms.
- Consider prescribing a proton pump inhibitor for gastrointestinal protection in people at risk of gastrointestinal bleeding or dyspepsia.
- Consider prescribing bone-sparing treatment, such as bisphosphonates, to people who are taking high doses of GC.
Abstract
Background and aim: Giant cell arteritis (GCA) remains a medical emergency because of the risk of sudden irreversible sight loss and rarely stroke along with other complications. Because headache is one of the cardinal symptoms of cranial GCA, neurologists need to be up to date with the advances in investigation and management of this condition. The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based recommendations on GCA.
Methods: The working group identified relevant questions, performed systematic literature review and assessed the quality of available evidence, and wrote recommendations. Where there was not a high level of evidence, the multidisciplinary (neurology, ophthalmology and rheumatology) group recommended best practice based on their clinical experience.
Results: Across Europe, fast track pathways and the utility of advanced imaging techniques are helping to reduce diagnostic delay and uncertainty, with improved clinical outcomes for patients. GCA is treated with high dose glucocorticoids (GC) as a first line agent however long-term GC toxicity is one of the key concerns for clinicians and patients. The first phase 2 and phase 3 randomised controlled trials of Tocilizumab, an IL-6 receptor antagonist, have been published. It is now been approved as the first ever licensed drug to be used in GCA.
Conclusion: The present article will outline recent advances made in the diagnosis and management of GCA.
Contents of the original publication
The section headings of the original.
- Objective
- Methods
- Background
- What are the characteristics of headache in GCA?
- Recommendation
- What are the presenting features of GCA, apart from new onset headache?
- Recommendation
- What is the best way to diagnose GCA?
- Laboratory markers
- Confirmatory investigational tests
- Imaging – cranial GCA
- Temporal artery biopsy
- Imaging – large vessel GCA (LV-GCA)
- Are there any other imaging modalities being utilised in GCA?
- What are the benefits of rapid access GCA diagnostic pathways?
- Recommendation
- What is the treatment of GCA?
- What is the immediate treatment for GCA?
- Recommendation
- What is the long-term GCA treatment?
- Recommendation
- How are the side-effects of glucocorticoids mitigated?
- Recommendation
- Are conventional second line steroid sparing therapies effective in GCA?
- Recommendation
- What is the evidence for antiplatelet therapy in GCA?
- Recommendation
- What is the evidence for use of biologics in GCA?
- Recommendation
- Conclusions
- Contributor Information
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