Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance
Abstract Background New 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...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | The Journal of Headache and Pain |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s10194-021-01252-4 |
| _version_ | 1818924543375310848 |
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| author | Simona Sacco Christian Lampl Antoinette Maassen van den Brink Valeria Caponnetto Mark Braschinsky Anne Ducros Patrick Little Patricia Pozo-Rosich Uwe Reuter Elena Ruiz de la Torre Margarita Sanchez Del Rio Alexandra J. Sinclair Paolo Martelletti Zaza Katsarava On behalf of the Burden and Attitude to Resistant and Refractory (BARR) Study Group |
| author_facet | Simona Sacco Christian Lampl Antoinette Maassen van den Brink Valeria Caponnetto Mark Braschinsky Anne Ducros Patrick Little Patricia Pozo-Rosich Uwe Reuter Elena Ruiz de la Torre Margarita Sanchez Del Rio Alexandra J. Sinclair Paolo Martelletti Zaza Katsarava On behalf of the Burden and Attitude to Resistant and Refractory (BARR) Study Group |
| author_sort | Simona Sacco |
| collection | DOAJ |
| description | Abstract Background New 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. Methods We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. Results There 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. Conclusions This 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. |
| first_indexed | 2024-12-20T02:27:00Z |
| format | Article |
| id | doaj.art-7f47e162ba404dc98e99802a6fd4a987 |
| institution | Directory Open Access Journal |
| issn | 1129-2369 1129-2377 |
| language | English |
| last_indexed | 2024-12-20T02:27:00Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | The Journal of Headache and Pain |
| spelling | doaj.art-7f47e162ba404dc98e99802a6fd4a9872022-12-21T19:56:41ZengBMCThe Journal of Headache and Pain1129-23691129-23772021-05-0122111010.1186/s10194-021-01252-4Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache AllianceSimona Sacco0Christian Lampl1Antoinette Maassen van den Brink2Valeria Caponnetto3Mark Braschinsky4Anne Ducros5Patrick Little6Patricia Pozo-Rosich7Uwe Reuter8Elena Ruiz de la Torre9Margarita Sanchez Del Rio10Alexandra J. Sinclair11Paolo Martelletti12Zaza Katsarava13On behalf of the Burden and Attitude to Resistant and Refractory (BARR) Study GroupNeuroscience section – Department of Biotechnological and Applied Clinical Sciences and (Edificio Coppito 2), University of L’AquilaDepartment of Neurology, Headache Medical Centre Linz, Hospital Barmherzige Brüder, Centre of Integrative Medicine (ZiAM) Ordensklinikum LinzDivision of Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center RotterdamNeuroscience section – Department of Biotechnological and Applied Clinical Sciences and (Edificio Coppito 2), University of L’AquilaHeadache Clinic, Department of Neurology, Tartu University ClinicsHeadache Unit, Neurology Department, Montpellier University Hospital and Montpellier UniversityEuropean Migraine & Headache Alliance (EMHA)Headache Unit, Neurology Department, Vall d’Hebron University HospitalCharité Universitätsmedizin Berlin, Department of Neurology, Charité Universitätsmedizin BerlinEuropean Migraine & Headache Alliance (EMHA)Neurology Department, Clinica Universidad de NavarraMetabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of BirminghamDepartment of Clinical and Molecular Medicine, Sapienza University of RomeChristian HospitalAbstract Background New 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. Methods We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. Results There 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. Conclusions This 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.https://doi.org/10.1186/s10194-021-01252-4MigraineResistant migraineRefractory migraineMigraine care |
| spellingShingle | Simona Sacco Christian Lampl Antoinette Maassen van den Brink Valeria Caponnetto Mark Braschinsky Anne Ducros Patrick Little Patricia Pozo-Rosich Uwe Reuter Elena Ruiz de la Torre Margarita Sanchez Del Rio Alexandra J. Sinclair Paolo Martelletti Zaza Katsarava On behalf of the Burden and Attitude to Resistant and Refractory (BARR) Study Group 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 Migraine Resistant migraine Refractory migraine Migraine care |
| title | Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance |
| title_full | Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance |
| title_fullStr | Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance |
| title_full_unstemmed | Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance |
| title_short | Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance |
| title_sort | burden and attitude to resistant and refractory migraine a survey from the european headache federation with the endorsement of the european migraine headache alliance |
| topic | Migraine Resistant migraine Refractory migraine Migraine care |
| url | https://doi.org/10.1186/s10194-021-01252-4 |
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