Abstract
Background: Preventive treatment of migraine is necessary for patients with frequent migraine attacks to avoid migraine progression and medication overuse. In the literature, there have been a few studies, and all of them have demonstrated the low prevalence of preventive-eligible migraine patients having received migraine preventive treatments.
Objective: This study aimed to investigate the prevalence of using preventive migraine treatments in treatment-eligible migraine patients in Thailand[HI1] .
Methods: A hospital registry-based cross-sectional study was conducted in migraine patients between January 2007 and June 2022 at the Chulalongkorn Comprehensive Headache Center, King Chulalongkorn Memorial Hospital, Thailand. Data collected at the first visit were extracted from the hospital patient registry. The proportion of using preventive migraine treatments among patients with variable migraine severity classified by the number of monthly migraine days were evaluated.
Results: Of the 681 patients in the registry, 572 migraine patients aged 15 years and older were included in analysis. The prevalence of migraine patients with a history of ever using preventive treatment was 14.7%. There was no significant difference in the prevalence of receiving preventive treatment among the patients with variable migraine severity classified by the number of monthly migraine days. Among the treatment-eligible migraine participants, the prevalence of using preventive treatments was 12.9[HI2] %.
Conclusion: This was the first hospital-based study in an Eastern country that revealed a prevailing low prevalence of using preventive treatments among migraine patients. Providing and using preventive treatment is critical to the progression of migraine. Health education on existing preventive treatments is needed to raise the awareness among the patients. More studies on this topic are needed in Asian countries to replicate these findings. To improve the scientific quality of studies on the prevalence of migraine patients with a history of ever using preventive migraine treatment, future research should be conducted with gathering data from primary data sources and retrieving previous treatments from medical records.
[HI1]Changing due to English language editing
[HI2]English language editing suggestion
DOI
10.56808/2673-060X.5507
First Page
Preventive treatment of migraine is necessary for those who have frequent migraine attacks to avoid progression to chronic migraine (CM), medication overuse, and medication overuse headaches (MOH). (1) Based on the frequency of migraine/headache days per month, migraine can be categorized into two groups, i.e., episodic migraine (EM) (less than 15 days) or CM (at least 15 days). (2) MOH is defined as a headache occurring at least 15 days per month with regular overuse of one or more drugs for the acute treatment of headaches for more than 3 months. (3) For acute treatment, the use of ergot derivatives, triptans, opioids, combination analgesics, or a combination of drugs from different classes for ten or more days per month or non-opioid analgesics, acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs) for fifteen or more days per month is considered medication overuse. (3) Preventive treatment aims to reduce the frequency, severity, duration, and disability of attacks; improve acute treatment responsiveness and avoid escalation; improve function and disability; improve health-related quality of life; and reduce headache-related distress and psychological symptoms. (3) Currently, preventive treatment should be offered to patients with six or more headache days per month, at least four headache days per month with some degree of disability, or at least three headache days per month with a severe degree of disability. (3) However, there has been a low prevalence of preventive-eligible patients receiving preventive treatment in clinical practice. The literature shows that there have been only five population-based studies on the epidemiology of preventive treatment use. (4-8) These studies reported low prevalence of using migraine preventive treatments among those who are preventive-eligible. According to a survey conducted in the United States (US), 25.7% of the 18,968 migraine patients aged 12 years or older met the criteria for receiving prevention treatment. Among the users 13.0% reported current daily use of preventive migraine medication, 25.5% previously used it, and 43.3% never used it. (4) In addition, approximately 38.0% of people with EM benefit from prophylactic therapy, but only 3% to 13% obtain it. (5) A population-based survey in the US revealed that the majority of the patients with probable migraine (52.8% of 7337 patients) never used migraine prevention; only 7.9% of patients currently used migraine prevention, whereas 19.9% of the patients used it in the past. (6) Another study investigated prescriptions from computerized data records of the Institute for Medical Statistics called “MediPlus” from Germany and revealed that of the 21,209 patients from outpatient primary care with a documented diagnosis of migraine, only 0.12 person-years out of 45,669 person-years received prescriptions for prophylactics. (7) In the most recent study, which used a web-based survey of the 16,789 oral preventive-eligible people with migraine, defined as having at least
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practitioners, general medicine physicians, internists, or general neurologists, possibly affecting the prescription of migraine preventive treatment to their eligible migraine patients; and no migraine disability assessment that needs to cooperate with the number of monthly migraine days to suggest migraine preventive treatments, such as at least four monthly migraine days with some degree of disability or at least three monthly migraine days with severe degree of disability. Implications for clinical practice are that the low prevalence of preventive treatment-eligible migraine patients having received migraine preventive treatments may lead to the progression of EM to CM and MOH. Patients with CM have a lower proportion of nausea and vomiting than those with EM, which may confirm the chronification or progression of migraine. The specific symptoms of migraine, such as nausea, vomiting, photophobia, and phonophobia, will have a lower prevalence while the frequency of migraine attacks increases. Patients with CM and CM with MOH have higher ictal burdens, including longer duration and higher pain scores of migraine headaches than those with EM. Proper management with migraine preventive treatments should be introduced. Conclusion This first hospital-based study revealed the same low prevalence and wide range of preventive treatment gaps in migraine patients with a history of ever using preventive migraine treatments among those who were preventive-eligible around the world, which may have led to the progression of EM to CM and MOH. The prompt education of physicians and patients should be initiated to realize the necessity of the use of preventive treatment. Due to no anti-CGRP medications included, it would have more value if a follow-up time was done with specific migraine preventive medications in a year or so to assess the difference between non-specific and specific migraine preventive medications. Future research to improve the scientific quality of studies on the prevalence of migraine patients with a history of ever using preventive migraine treatment, should be conducted with gathering data from the primary data sources and retrieving previous treatment from medical records.
Recommended Citation
Asawavichienjinda, Thanin
(2024)
"Treatment gaps in preventive treatment-eligible migraine patients: a hospital-based study in Thailand,"
Chulalongkorn Medical Journal: Vol. 69:
Iss.
1, Article 7.
DOI: https://doi.org/10.56808/2673-060X.5507
Available at:
https://digital.car.chula.ac.th/clmjournal/vol69/iss1/7
