Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance

The Journal of Headache and Pain

Uwe Reuter¹  Zaza Katsarava²  Paolo Martelletti³  Christian Lampl⁴  Antoinette Maassen van den Brink⁵  Patrick Little⁶  Elena Ruiz de la Torre⁶  Mark Braschinsky⁷  Anne Ducros⁸  Patricia Pozo-Rosich⁹  Alexandra J. Sinclair^1,10  Margarita Sanchez Del Rio^1,11  Valeria Caponnetto^1,12  Simona Sacco^1,12 

[1] Charité Universitätsmedizin Berlin, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany;Christian Hospital, Unna, Germany;Department of Neurology, University of Duisburg-Essen, Essen, Germany;EVEX Medical Corporation, Tbilisi, Georgia;IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation;Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy;Regional Referral Headache Center of the Lazio Region, Sant’Andrea Hospital, Rome, Italy;Department of Neurology, Headache Medical Centre Linz, Hospital Barmherzige Brüder, Centre of Integrative Medicine (ZiAM) Ordensklinikum Linz, Linz, Austria;Division of Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands;European Migraine & Headache Alliance (EMHA), Brussels, Belgium;Headache Clinic, Department of Neurology, Tartu University Clinics, Tartu, Estonia;Headache Unit, Neurology Department, Montpellier University Hospital and Montpellier University, Montpellier, France;Headache Unit, Neurology Department, Vall d’Hebron University Hospital, Barcelona, Spain;Headache and Neurological Pain Research Group, Department de Medicina, Universitat Autònoma de Barcelona, Vall d’Hebron Research Institute, Barcelona, Spain;Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK;Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK;Neurology Department, Clinica Universidad de Navarra, Madrid, Spain;Neuroscience section – Department of Biotechnological and Applied Clinical Sciences and (Edificio Coppito 2), University of L’Aquila, Via Vetoio, 67100, L’Aquila, Italy;Regional Referral Headache Center of the Abruzzo Region, ASL Avezzano-Sulmona-L’Aquila, L’Aquila, Italy;

关键词: Migraine;    Resistant migraine;    Refractory migraine;    Migraine care;   

DOI  :  10.1186/s10194-021-01252-4

来源: Springer

【 摘 要 】

BackgroundNew treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standardized way. The Consensus proposed well-defined criteria for resistant migraine (i.e., patients who do not respond to some treatment but who have residual therapeutic opportunities) and refractory migraine (i.e., patients who still have debilitating migraine despite maximal treatment efforts).The aim of this study was to better understand the perceived impact of resistant and refractory migraine and the attitude of physicians involved in migraine care toward those conditions.MethodsWe conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care.ResultsThere were 277 questionnaires available for analysis. A relevant proportion of participants reported that patients with resistant and refractory migraine were frequently seen in their clinical practice (49.5% for resistant and 28.9% for refractory migraine); percentages were higher when considering only those working in specialized headache centers (75% and 46% respectively). However, many physicians reported low or moderate confidence in managing resistant (8.1% and 43.3%, respectively) and refractory (20.7% and 48.4%, respectively) migraine patients; confidence in treating resistant and refractory migraine patients was different according to the level of care and to the number of patients visited per week. Patients with resistant and refractory migraine were infrequently referred to more specialized centers (12% and 19%, respectively); also in this case, figures were different according to the level of care.ConclusionsThis report highlights the clinical relevance of difficult-to-treat migraine and the presence of unmet needs in this field. There is the need of more evidence regarding the management of those patients and clear guidance referring to the organization of care and available opportunities.

【 授权许可】

CC BY