A Survey on Probable and Improbable Decisions About Headache Treatment

Abstract

The treatment of headache disorders is adapted to their severity. It is the aim of this study to evaluate the probability of treatment decisions being taken and to identify underlying principles influencing them. The study was internet-based and cross-sectional; participants completed the EUROLIGHT questionnaire anonymously. Inclusion criterion was the consent to participate. Participants were excluded if diagnostic questions had not been completed. We estimated probabilities based on relative frequencies and built binary logistic regression models to identify factors influencing decision-making. The survey was completed by 976 individuals; 636 completed the diagnostic questions. The probability of a patient to consult a GP or a neurologist was 0.26 and 0.20, respectively. Patients decided by a probability of 0.93 to take acute treatment. These treatment decisions, which were taken by patients alone increased in probability with increasing ictal burden (P < 0.001, P < 0.001 and P < 0.001). The probability of treating migraine with triptans was 0.74; the probability to take a prophylactic treatment was 0.43. Neurologists were more likely than GPs to prescribe these medications (P = 0.006 and P < 0.001, respectively). We identified several principles underlying treatment decisions. Most patients decide to take acute treatment for headache attacks; they are less likely to treat their headache disorder interictally. Treatment decisions are less likely to be taken if more than one decision-maker is involved; if physicians are involved, severity of the headache disorder does not affect the probability of a treatment decision being taken. Overall, the more severely affected a headache patient, the less likely an adequate treatment.

Development and validation of a web-based headache diagnosis questionnaire

“…Clinical decision systems have shown effectiveness for improving clinical practice 19,20 . Thus, a clinical decision system based on the headache diagnosis using web-based questionnaire would be a good choice in the management of headache 16,21,22 . Also, web-based questionnaire could promptly assess changes in headache characteristics and in treatment strategies during public health emergency situation like coronavirus disease 2019 pandemic 23,24 .…”

What to do with non-responders to CGRP(r) monoclonal antibodies: switch to another or move to gepants?

“…Of course clinical decisions in migraine, a complex and changing disease in the various phases of the life of the human being who suffers from it, are dictated by adherence to guidelines, but never detached from sound clinical experience [ 35 – 37 ]. Indeed, we know that the patient's therapeutic response is influenced by complex variables that are intrinsic to the patient or environmental in nature, and that the partial or non-response to a drug cannot be simplistically resolved by overlapping numerically more than one, especially if it has the same molecular target [ 38 – 40 ].…”

Evaluating Headache and Facial Pain in a Headache Diagnostic Laboratory: Experiences from the Danish Headache Center

“…Rare primary and secondary headaches also need to be phenotyped as well as the effect of off-label treatment. The testing and use of digital diagnostic tools [ 49 , 50 , 51 ] and headache calendars would also be of interest in future studies. Imaging studies have been useful in illuminating the pathophysiology of migraine and may be a future biomarker for treatment response [ 52 ].…”