Study on management of headache by general practitioners in South Italy

Iannacchero, Rosario; Cannistrà, Umberto; Vitola, Antonio La; Peltrone, Francesco; Caro, Enzo De

doi:10.1007/s10194-005-0218-6

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…In our country physicians may prescribe off‐label treatment on their own responsibility and only after receiving the patient's informed consent (39). Administration of drugs without evidence of efficacy for migraine prophylaxis strongly suggests the need for educational programmes on evidence‐based medicine in Italy (40), but it might also be the expression of a selection of severe cases of non‐responders to usual treatments. The complex comorbidity of our patients, which appears to be important for a population with a mean age of 37 years, might be an expression of this selection.…”

Section: Discussionmentioning

confidence: 99%

Underdiagnosis and Undertreatment of Migraine in Italy: A Survey of Patients Attending for The First Time 10 Headache Centres

Cevoli

D’Amico

Martelletti³

et al. 2009

Cephalalgia

102

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The aim of this study was to asses the clinical features, pattern of healthcare and drug utilization of migraine patients attending 10 Italian headache centres (HC). Migraine is underdiagnosed and undertreated everywhere throughout the world, despite its considerable burden. Migraine sufferers often deal with their problem alone using self-prescribing drugs, whereas triptans are used by a small proportion of patients. All patients attending for the first time 10 Italian HCs over a 3-month period were screened for migraine. Migraine patients underwent a structured direct interview about previous migraine diagnosis, comorbidity, headache treatments and their side-effects and healthcare utilization for migraine. Patient satisfaction with their usual therapy for the migraine attack was evaluated with the Migraine-Assessment of Current Therapy (ACT) questionnaire. The quality of life of migraine patients was assessed by mean of Short Form (SF)-12 and Migraine-Specific Quality of life (MSQ) version 2.1 questionnaires. Of the 2675 patients who attended HCs for the first time during the study period, 71% received a diagnosis of migraine and the first 953 subjects completed the study out of 1025 patients enrolled. Only 26.8% of migraine patients had a previous diagnosis of migraine; 62.4% of them visited their general practitioner (GP) in the last year, 38.2% saw a specialist for headache, 23% attended an Emergency Department and 4.5% were admitted to hospital for migraine; 82.8% of patients used non-specific drugs for migraine attacks, whereas 17.2% used triptans and only 4.8% used a preventive migraine medication. Triptans were used by 46.4% of patients with a previous diagnosis of migraine. About 80% of migraine patients took over-the-counter medications. The Migraine-ACT revealed that 60% of patients needed a change in their treatment of migraine attacks, 85% of whom took non-specific drugs. Both the MSQ version 2.1 and the SF-12 questionnaires indicated a poor quality of life of most patients. Migraine represents the prevalent headache diagnosis in Italian HCs. Migraine is still underdiagnosed in Italy and migraine patients receive a suboptimal medical approach in our country, despite the healthcare utilization of migraine subjects being noteworthy. A cooperative network involving GPs, neurologists and headache specialists is strongly desirable in order to improve long-term migraine management in Italy.

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Section: Discussionmentioning

confidence: 99%

Underdiagnosis and Undertreatment of Migraine in Italy: A Survey of Patients Attending for The First Time 10 Headache Centres

Cevoli

D’Amico

Martelletti³

et al. 2009

Cephalalgia

102

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“…Providers are often untrained and unmotivated to diagnose and treat headache patients [4,5,6,7,8,9,10] and many have an inappropriate perception of the burden of headache disorders [4,11] or consider headaches a somatoform disorder [12,13,14]. This results in misdiagnosis [6,11,15] and ineffective treatment [6,7,11], which increases patient dissatisfaction and insecurity [15] with consequent doctor ‘shopping', unnecessary testing and inadequate self-treatment.…”

Section: Introductionmentioning

confidence: 99%

Headache from the Doctors' Perspective

Gil‐Gouveia¹

2014

Eur Neurol

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Background: General practitioners (GPs) and neurologists are involved in treating headache patients in Portugal. Having migraine themselves might influence the way they perceive and treat migraine patients. Objective: To identify clinicians' perceptions about migraine, their own headache status and management of their own migraine. Methods: An observational cross-sectional survey of GPs and neurologists using anonymous questionnaires including demographic data, headache and migraine status and migraine perception questions. Results: Of 348 respondent physicians, 20% were neurologists and 53% were females with an average age of 48 years. The majority had an interest in migraine and considered it disabling (93%), although 65-85% reported management difficulties, GPs more often than neurologists. Satisfaction with current treatment options was high (69-79%). 63 physicians suffered from migraine and 81% felt it influenced their perception of the disease. Portuguese physicians preferentially treat their own migraines with NSAIDs (33%), analgesics (29%) and triptans (20%). Conclusion: Portuguese physicians treating migraine patients have realistic perceptions about the disease and those with migraine feel their perception is influenced by their experience. Although reporting management difficulties, the majority of physicians are satisfied with current treatment options for migraine.

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“…CME should be done with evidence-based medicine (EBM), which promotes the use of current best evidence in making decisions about the health care of individual patients. Its practice means integrating individual clinical expertise with clinical evidence from systematic research and its main principle is that clinical decisions should be based on the best available scientific evidence of previous experience and the conclusions based on such evidence should stimulate quality improvements in patient care 8 . It is important to say that CME must not only emphasize the acquisition of knowledge, but also instruct physicians in the process of decision making to help enable them to better use their knowledge and make clinical judgments 9 .…”

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confidence: 99%