Clinical Features and Pharmacological Treatment of Migraine Patients Referred to Headache Specialists in Canada

Abstract

We set out to examine selected clinical characteristics of migraine patients referred to neurologists specializing in headache in Canada, and to document their pharmacological therapy both before and after consultation with the neurologist. Demographic, clinical and pharmacotherapy data were collected at the time of consultation for 606 patients referred to five headache clinics and who were given a migraine diagnosis by the neurologist. Data were analysed as part of the Canadian Headache Outpatient Registry and Database (CHORD) Project. The mean age of the migraine patients was 39.7 years; and 82.5% were female. The majority of patients suffered severe impact from their headaches. Prior to consultation, 48.7% were taking a triptan; after consultation, 97.2% were on a triptan. Before consultation, 30.9% were on a prophylactic drug; after consultation, 70.4% were. 20.8% of patients were medication overusers. Of these medication overusers, 42.4% were overusing an opiate, usually in combination with other analgesics; 21.6% were overusing a triptan. Medication changes made by the neurologists at consultation included a large increase in the use of both triptans and prophylactic medications. Medication overuse, particularly opiate overuse, remains a significant problem in patients with migraine in Canada.

How general practitioners treat migraine patients—evaluation of a headache guideline

“…In a Canadian study, 606 migraine patients referred to neurologists specializing in headache showed that only 7.6% used anti-emetic drugs before referral, and almost 19% after consultation. However, the study did not clearly state which patients had an indication for treatment with anti-emetics (8). It seems that nausea and vomiting in migraine patients are undertreated phenomena, although guidelines recommend the prescription of anti-emetics.…”

Current aspect of the diagnosis and management of migraine

“…К сожалению, лечение мигрени обыч-но не оптимально, так как не назначаются триптаны и про-филактическая терапия [37,38].…”

Prophylaxis of migraine headache

“…According to estimates, about 25% of all migraine sufferers should be offered prophylactic therapy, 7 and prophylactic medications are thought to be underutilized. 5 When migraine prophylactic therapy is started, one of three outcomes can be anticipated. The patient may show substantial benefit, which is usually defined as a reduction in frequency of headaches of 50% or more.…”

“…1,4 The Canadian Headache Outpatient Registry and Database Project found that 21% of patients with a diagnosis of migraine who were referred to headache specialists had symptomatic medication overuse. 5 When prophylaxis should be started is a matter of clinical judgement. Evidence on which to base this decision is lacking, and many medications are available from which to choose.…”