Introduction: Migraine and asthma are two frequent, disabling, chronic disorders with a major impact on patient well-being. The objectives of this study were to compare subjective well-being between patients with severe forms of migraine or asthma using a panel of PROs. Methods: Adult patients were recruited during routine consultations with chest physicians or neurologists. Patients with severe migraine (reporting headaches on ≥8 days/month and having failed ≥2 prophylactic treatments) and patients with severe asthma (according to the 2017 GINA definition: requiring Step 4 or 5 treatment or presenting uncontrolled symptoms) were eligible. Each patient completed the EuroQol Questionnaire (EQ-5D-5L), the Work Productivity and Activity Impairment Questionnaire (WPAI) and the Hospital Anxiety and Depression scale (HAD). Patients with severe migraine the 6-item Headache Impact Test (HIT-6) and those with severe asthma completed the Asthma Control Test (ACT). Results: 249 patients with severe migraine and 96 with severe asthma were enrolled. Mean EQ-5D-5L utility scores were significantly higher in the severe migraine group than in the severe asthma group (0.75±0.25 vs 0.68±0.26; p<0.01). Low EQ-5D-5L utility scores were associated with frequent (≥15 headache days/month) or disabling (HIT-6 score ≥60) headaches and with poor asthma control. Patients with severe migraine more frequently presented a HAD depression score ≥11 (23.0% in severe migraine; 7.5% in severe asthma; p<0.01), whereas those with severe asthma more frequently reported problems with mobility, self-care and usual activities. Absenteeism (percent worktime missed) was similar in both groups (severe migraine: 9.0%±19.1%; severe asthma: 13.8%±22.9%) but work impairment was higher in the severe migraine group (44.3% vs 28.4%; p<0.01). Conclusion: Quality of life, work activity and psychological distress are all deteriorated in both severe migraine and severe asthma. Different aspects are affected in the two diseases: a greater impact on psychological aspects in severe migraine and a greater impact on physical aspects in severe asthma.
OBJECTIVES: To understand the characteristics and management of Portuguese patients suffering from migraine who have failed two or more preventive treatments. METHODS: A worldwide, cross-sectional, online survey was conducted including migraine patients recruited via online panels and patient organizations from September 2017 to February 2018. Study participants were adults reporting 4 or more monthly migraine days over the 3 months previous to survey. Portuguese patients who have failed two or more preventive treatments were selected for this analysis. RESULTS: A total of 88 patients were included: 76.1% were female, mean age 39.5 years (range: 19-72 years), 77.3% employed and 61.4% married. More than half (52.3%) referred being affected by migraine for more than 10 years, 82.9% reported other chronic conditions (42.1% anxiety, 37.5% depression, 30.7% insomnia/ sleep disorder) and 64.8% had family history of migraine. Patients reported an average of 10.3 migraine days in the previous month (SD 7.4; range 4-31). Migraine was mainly diagnosed/treated by neurologists (57.7%/42.0%) followed by GPs (30.8%/39.8%). 45.5% of patients reported an "attack phase" duration of one or more days. Almost all participants have migraine-related sleeping difficulties (97.7%) and need long periods in darkness or isolated (93.2%; average: 12.5 hours/month; range 1-80) during a migraine attack. About 79.6% take acute medication (82.9% prescribed by doctor and 51.4% over-the-counter) namely pain relievers (81.4%), triptans (35.7%), anti-emetics (22.8%), opioids (21.4%), corticosteroids (17.1%) and ergots (14.3%). Current preventive treatments included anti-depressants (43.2%; 60.5% for +2 years), beta-blockers (25.0%; 45.5% for +2 years), anti-epileptics (31.8%; 64.3% for +2 years) among others. In 76.2% participants, preventive treatment was changed three or more times. CONCLUSIONS: This survey provides valuable insight about characteristics and management of difficult-to-treat migraine patients in Portugal and highlights unmet needs in the management of these patients that still need to be addressed.
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