Abstract
BackgroundMigraine is a frequent headache disorder with high disease burden. The aims of this study were to determine the administrative prevalence and incidence of migraine in Germany; and to elucidate disease characteristics, prescription patterns and the patient journey through the German healthcare system.MethodsIn this retrospective, observational study, adult patients with migraine (International Classification of Diseases, 10th revision, German modification G43) were identified in the anonymised German Company Sickness Fund database (CSFD) from 2008 through 2016. The administrative prevalence and incidence of migraine were calculated for the total CSFD study population and extrapolated to the German Statutory Health Insurance (SHI) population. Migraine subtypes, concurrent diagnoses, prescription patterns and visited healthcare professional groups were analysed.ResultsA total of 243,471 patients with migraine were identified in the CSFD (2008–2016); 78.0% were female and 45.3% were aged 35–54 years. The administrative prevalence of migraine, extrapolated to the SHI population, ranged between 2.89% in 2008 and 3.98% in 2016; administrative incidence ranged from 0.587% in 2009 to 0.267% in 2016, and varied between 0.399% and 0.442% during 2011 to 2015. Overall, 29.1% of patients received at least one prescription for any preventive medication listed in the German guideline. Only 7.9% received the same preventive medication for more than 1 year, with 82.9% of these patients discontinuing the medication before study end. Regarding acute medications, 74.2% of prescriptions were for analgesics/non-steroidal anti-inflammatory drugs and 21.2% were for triptans. General practitioners most commonly diagnosed and treated migraine in the CSFD population. Patients with prescriptions for two or more different preventive therapy classes had higher use of acute and emergency medications, and visited healthcare professionals and hospitals more frequently than patients with no prescriptions or prescriptions for only one preventive therapy class.ConclusionsThe administrative prevalence of migraine in this claims database suggests many patients with migraine did not seek medical care. Of those who did, fewer than one-third received preventive medication, with most patients having been prescribed only one such medication and few having continued treatment beyond 1 year. These outcomes suggest there is scope for improvement in migraine management in Germany.
Highlights
Migraine is a frequent headache disorder with high disease burden
Migraine is a disabling primary headache disorder [1] characterised by headaches and associated symptoms including aura, photophobia, phonophobia and nausea/ vomiting [2, 3], which can lead to considerable disruption of the professional and private lives of affected individuals [4, 5]
Throughout the analysis period, the same ICD-10-GM G43 diagnosis was documented for 63.1% of patients, while at least two different ICD-10-GM G43 diagnoses were documented for 36.9% of patients
Summary
Migraine is a frequent headache disorder with high disease burden. Migraine is a disabling primary headache disorder [1] characterised by headaches and associated symptoms including aura, photophobia, phonophobia and nausea/ vomiting [2, 3], which can lead to considerable disruption of the professional and private lives of affected individuals [4, 5]. The treatment of patients with migraine aims to relieve pain or limit the attack, reduce disability and restore function, improve health-related quality of life and manage comorbidities [2, 7]. Pharmacological therapy comprises both acute and preventive treatments [8]. Acute treatment options include analgesics (foremost non-steroidal anti-inflammatory drugs [NSAIDs]), antiemetics (e.g. metoclopramide), triptans (e.g. almotriptan, oral or subcutaneous sumatriptan) and emergency medications (e.g. intravenous metoclopramide, subcutaneous sumatriptan) [8]. Opioids and ergotamines take a special position in the acute treatment algorithm, and they are generally not recommended by the guideline of the German Migraine and Headache Society and the German Society of Neurology (hereafter referred to as the German guideline for migraine) for reasons of toxicity and other adverse effects [8]
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