Shortcomings and missed potentials in the management of migraine patients - experiences from a specialized tertiary care center

TY - JOUR

T1 - Shortcomings and missed potentials in the management of migraine patients - experiences from a specialized tertiary care center

AU - Ziegeler, Christian

AU - Brauns, Greta

AU - Jürgens, Tim P

AU - May, Arne

PY - 2019/8/1

Y1 - 2019/8/1

N2 - BACKGROUND: Migraine is a common and severely disabling neurological disorder affecting millions of patients in Europe. Despite the availability of evidence-based national and international guidelines, the management of migraine patients often remains poor, which is often attributed to a low availability of headache specialists. The aim of this study was to investigate the adherence to national guidelines and to assess the possible potential of optimized therapy regimens in migraine patients.METHODS: We collected data of migraine patients presenting to our out-patient clinic via standardized questionnaires regarding headache, diagnostics and experience with previous treatments. We also assessed the efficacy of treatment started by our center.RESULTS: 1,935 migraine patients were included between 2010 and 2018. In the 12 months before consulting our headache clinic 89.5% of the patients had consulted a general practitioner and 74.9% had consulted a neurologist because of their migraine. Nevertheless, 50% of the patients underwent unnecessary diagnostics and 34.2% had not been treated according to evidence-based treatment guidelines. Out of 1,031 patients who had not been prescribed a preventative treatment 627 (60.8%) had in average 3 or more migraine attacks per month and thus qualified for a preventative treatment. These patients missed in the 3 months prior to consultation on average 5 work or school days. Initiating a preventative treatment was effective in 71.2% of the patients, that provided follow-up data.CONCLUSIONS: Our data suggest, that many migraine patients to this day do not receive state-of-the-art therapy. Adherence to national and international European guidelines could improve the outcome in migraine patients. Future research should try to answer why guidelines are not followed.

AB - BACKGROUND: Migraine is a common and severely disabling neurological disorder affecting millions of patients in Europe. Despite the availability of evidence-based national and international guidelines, the management of migraine patients often remains poor, which is often attributed to a low availability of headache specialists. The aim of this study was to investigate the adherence to national guidelines and to assess the possible potential of optimized therapy regimens in migraine patients.METHODS: We collected data of migraine patients presenting to our out-patient clinic via standardized questionnaires regarding headache, diagnostics and experience with previous treatments. We also assessed the efficacy of treatment started by our center.RESULTS: 1,935 migraine patients were included between 2010 and 2018. In the 12 months before consulting our headache clinic 89.5% of the patients had consulted a general practitioner and 74.9% had consulted a neurologist because of their migraine. Nevertheless, 50% of the patients underwent unnecessary diagnostics and 34.2% had not been treated according to evidence-based treatment guidelines. Out of 1,031 patients who had not been prescribed a preventative treatment 627 (60.8%) had in average 3 or more migraine attacks per month and thus qualified for a preventative treatment. These patients missed in the 3 months prior to consultation on average 5 work or school days. Initiating a preventative treatment was effective in 71.2% of the patients, that provided follow-up data.CONCLUSIONS: Our data suggest, that many migraine patients to this day do not receive state-of-the-art therapy. Adherence to national and international European guidelines could improve the outcome in migraine patients. Future research should try to answer why guidelines are not followed.

KW - Adult

KW - Ambulatory Care Facilities

KW - Europe/epidemiology

KW - Female

KW - Headache/epidemiology

KW - Humans

KW - Male

KW - Middle Aged

KW - Migraine Disorders/therapy

KW - Surveys and Questionnaires

KW - Tertiary Care Centers

U2 - 10.1186/s10194-019-1034-8

DO - 10.1186/s10194-019-1034-8

M3 - SCORING: Journal article

C2 - 31370788

VL - 20

SP - 86

JO - J HEADACHE PAIN

JF - J HEADACHE PAIN

SN - 1129-2369

IS - 1

ER -