Migraine is prevalent everywhere, and disabling. It is also neglected: consequently, it is under-diagnosed and undertreated. We analysed data from the Eurolight study on consultations and utilization of migraine-specific medications as indicators of adequacy of medical care in Europe.
Eurolight was a cross-sectional questionnaire-based survey in 10 European countries. Sampling was population-based in six (Germany, Italy, Lithuania, Luxembourg, Netherlands, Spain) and from consecutive patients attending general practitioners (GPs) for any reason in three (Austria, France, UK). Additional samples in Netherlands and Spain, and the only sample from Ireland, were recruited by lay headache organisations. We recorded migraine prevalence and frequency, and utilization of medical services and medications (acute and preventative).
Among 9247 participants (mean age 43.9 ± 13.9 years, M/F ratio 1:1.4), 3466 (37.6%) were diagnosed with migraine (definite or probable). Of these, 1175 (33.8%) reported frequent migraine (> 5 days/month) and might clearly expect benefit from, and therefore had need of, preventative medication. In population-based samples, minorities of participants with migraine had seen a GP (9.5–18.0%) or specialist (3.1–15.0%), and smaller minorities received adequate treatment: triptans 3.4–11.0%, with Spain outlying at 22.4%; preventative medication (1.6–6.4% of those eligible, with Spain again outlying at 13.7%). Proportions were greater in GP-based samples (13.6–24.5% using triptans, 4.4–9.1% on preventative medication) and among those from lay organisations (46.2–68.2% and 16.0–41.7%). Participants with migraine who had consulted specialists (3.1–33.8%) were receiving the best care by these indicators; those treated by GPs (9.5–29.6%) fared less well, and those dependent on self-medication (48.0–84.2%) were, apparently, inadequately treated.
In wealthy European countries, too few people with migraine consult physicians, with proportionately too many of these seeing specialists, and migraine-specific medications are used inadequately even among those who do. These findings represent yet another call for action in Europe to improve care for people with headache. Education of both health-care providers and the public should be central to this action.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D et al (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet 380:2163–2196 CrossRefPubMed
Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, Charlson F, Davis A, Degenhardt L, Dicker D, Duan L, Erskine H, Feigin VL, Ferrari AJ, Fitzmaurice C, Fleming T, Graetz N, Guinovart C, Haagsma J, Hansen GM, Hanson SW, Heuton KR, Higashi H, Kassebaum N, Kyu H, Laurie E, Liang X, Lofgren K, Lozano R, MacIntyre MF et al (2015) Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet 386:743–800 CrossRef
Steiner TJ, Birbeck GL, Jensen RH, Katsarava Z, Stovner LJ, Martelletti P (2015) Headache disorders are third cause of disability worldwide. J Headache Pain 16:54 CrossRef
Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, Carter A, Casey DC, Charlson FJ, Chen AZ, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Dilegge T, Erskine HE, Ferrari AJ, Fitzmaurice C, Fleming T, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Johnson CO, Kassebaum NJ, Kawashima T, Kemmer L, Khalil IA, Kinfu Y, Kyu HH, Leung J, Liang X et al (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the global burden of disease study 2015. Lancet 388:1545–1602 CrossRef
World Health Organization, Lifting The Burden (2011) Atlas of headache disorders and resources in the world 2011. Geneva: WHO
Andrée C, Stovner LJ, Steiner TJ, Barré J, Katsarava Z, Lainez JM, Lantéri-Minet M, Mick G, Rastenyte D, Ruiz dela Torre E, Tassorelli C, Vriezen P, Lampl C (2011) The Eurolight project: the impact of primary headache disorders in Europe. Description of methods. J Headache Pain 12:541–549 CrossRefPubMedPubMedCentral
Andrée C, Vaillant M, Barré J, Katsarava Z, Lainez JM, Lair ML, Lantéri-Minet M, Lampl C, Steiner TJ, Stovner LJ, Tassorelli C, Sándor PS (2010) Development and validation of the EUROLIGHT questionnaire to evaluate the burden of primary headache disorders in Europe. Cephalalgia 30:1082–1100 CrossRefPubMed
Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders: 2nd edition. Cephalalgia 24(suppl 1):9–160
Steiner TJ, Gururaj G, Andrée C, Katsarava Z, Ayzenberg I, Yu S-Y, Al Jumah M, Tekle-Haimanot R, Birbeck GL, Herekar A, Linde M, Mbewe E, Manandhar K, Risal A, Jensen R, Queiroz LP, Scher AI, Wang SJ, Stovner LJ (2014) Diagnosis, prevalence estimation and burden measurement in population surveys of headache: presenting the HARDSHIP questionnaire. J Headache Pain 15:3 CrossRefPubMedPubMedCentral
Stovner LJ, Al Jumah M, Birbeck GL, Gururaj G, Jensen R, Katsarava Z, Queiroz LP, Scher AI, Tekle-Haimanot R, Wang SJ, Steiner TJ (2014) The methodology of population surveys of headache prevalence, burden and cost: principles and recommendations from the global campaign against headache. J Headache Pain 15:5 CrossRefPubMedPubMedCentral
Kirthi V, Derry S, Moore R (2013) Aspirin with or without an antiemetic for acute migraine headaches in adults. Cochrane database of systematic reviews 30; art no CD008041. DOI: https://doi.org/10.1002/14651858.CD008041.pub3
Rabbie R, Derry S, Moore RA (2013) Ibuprofen with or without an antiemetic for acute migraine headaches in adults. Cochrane database of systematic reviews 30; art no CD008039. DOI: https://doi.org/10.1002/14651858.CD008039.pub3
Derry S, Moore R (2013) Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults. Cochrane database of systematic reviews 30; art no CD008040. DOI: https://doi.org/10.1002/14651858.CD008040.pub3
Cevoli S, D'Amico D, Martelletti P, Valguarnera F, Del Bene E, De Simone R, Sarchielli P, Narbone M, Testa L, Genco S, Bussone G, Cortelli P (2009) Underdiagnosis and undertreatment of migraine in Italy: a survey of patients attending for the first time 10 headache centres. Cephalalgia 29:1285–1293 CrossRefPubMed
Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, Sándor PS; European Federation of Neurological Societies (2009) EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force. Eur J Neurol 16: 968–981
Steiner TJ, Paemeleire K, Jensen R, Valade D, Savi L, Lainez MJA, Diener H-C, Martelletti P, Couturier EGM (2007) European principles of management of common headache disorders in primary care. J Headache Pain 8(suppl 1):S3–S21 PubMed
Steiner TJ (2013) Headache in the world: public health and research priorities. Expert Rev Pharmacoecon Outcomes Res 14:51–57 CrossRef
- Poor medical care for people with migraine in Europe – evidence from the Eurolight study
Timothy J. Steiner
- Springer Milan
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