InterMiG: international differences in the therapeutic approach to migraine patients in specialized headache centers

Abstract

Background There is currently a wide therapeutic arsenal for migraine patients, without a single first-line preventive drug and we choose the different available alternatives taking into account comorbidities, national guidelines, previous treatments and personal experiences. Our objective was to evaluate the differences in the use of migraine treatments between neurologists from different countries. Methods This is a multi-centre observational study carried out by neurologists from specialized headache units in seven countries, retrospective with consecutive inclusion of all patients presenting with a migraine diagnosis, over a period of three months. Results A total of 734 patients were recruited but only 600 were considered in the analysis in order to homogenize the patient cohorts from countries: 200 Spain (ES), 100 Italy (IT), 85 Russia (RUS), 80 Germany (DE), 60 Portugal (PT), 45 Poland (PL) and 30 Australia (AU). 85.4 % of patients were women with a mean age of 42.6 ± 11.8 years. Considering previous and current preventive treatment, the order of use was: antidepressants (69.3 %), antiepileptic drugs (54.7 %), beta-blockers and antihypertensive drugs (49.7 %), OnabotulinumtoxinA (44.0 %) and others (36.2 %). Statistically significant differences were found between all pharmacological classes: antidepressants were commonly used in all countries, with the exception of Poland (AU: 76.7 %, IT: 71.0 %, DE: 60.0 %, PL: 31.1 %, PT: 71.7 %, RUS: 70.6 %, ES: 78.5 %; p < 0.0001); antiepileptic drugs were more frequently prescribed in Portugal, Australia and Spain (AU: 73.3 %, IT: 40.0 %, DE: 37.5 %, PL: 48.9 %, PT: 85.0 %, RUS: 29.4 % and ES: 69.0 %; p < 0.0001); beta-blockers and antihypertensive drugs were frequently used in all countries except Italy (AU: 60.0 %, IT: 14.0 %, DE: 53.8 %, PL: 48.9 %, PT: 68.3 %, RUS: 49.4 % and ES: 59.0 %; p < 0.0001); BTX-A were predominately used in Spain, Italy and Australia (AU:56.7 %, IT:58.0 %, DE:20.0 %, PL: 42.2 %, PT: 26.7 %, RUS: 24.7 % and ES: 58.5 %; p < 0.0001) and others were most frequently used in Poland (AU: 0.0 %, IT: 19.0 %, DE: 42.5 %, PL: 95.6 %, PT: 31.7 %, RUS: 3.5 % and ES: 49.5 %; p < 0.0001). If only patients without comorbidities are considered (200/600), statistically differences between countries persist in all preventive treatments. Conclusions There is heterogeneity in the choice of preventive treatment between different countries. Prospective comparative studies of the different oral and subcutaneous alternatives would help to create a global therapeutic algorithm that would guarantee the best option for our patients.

The Registry for Migraine (REFORM) study: methodology, demographics, and baseline clinical characteristics

“…The study population had a high burden of disease, with 64.7% diagnosed with chronic migraine, 35.4% with MOH, and an average of 14.5 ± 7.0 MMDs per month. Headache frequency was comparable to reports from some tertiary headache clinics [ 21 ], while others has reported lower [ 22 , 23 ]. The high migraine burden might, in part, be due to the inclusion criteria of at least four MMDs in the three months prior to screening.…”

“…The REFORM study was a single-center, prospective, longitudinal, observational cohort study conducted to identify predictors of response to erenumab and biomarkers for migraine. The study included 751 participants with migraine, of whom 88.8% were female, which is higher than that of the general population [ 20 ], but consistent with that of people with migraine in other tertiary care units [ 21 – 23 ]. The study population had a high burden of disease, with 64.7% diagnosed with chronic migraine, 35.4% with MOH, and an average of 14.5 ± 7.0 MMDs per month.…”

“…Participants in the REFORM study frequently used triptans (89.3%) and preventive medications (48.5%). Compared to other specialized headache clinics, they used candesartan more frequently (18.5%), while the use of onabotulinumtoxinA was less common (13.0%) [ 21 ]. The restricted use of onabotulinumtoxinA is likely attributed to local practice guidelines, requiring patients to meet specific criteria before treatment commencement.…”

Acute Treatment of Migraine: Expert Consensus Statements from the United Arab Emirates (UAE)

“…Cultural and regional factors impact patient and physician preferences and opinions, which, in turn, influence migraine treatment choice. Differences in patient referral systems also contribute to heterogeneity in acute and preventive migraine treatment prescribing practices across countries [ 17 ]. Regional studies on such practice trends are lacking in the UAE, making it challenging to establish UAE-specific treatment goals.…”