Abstract
BackgroundMany different preventatives have showed efficacy in the treatment of migraine. National guidelines differ in their recommendations and patients’ characteristics are usually taken into account in their selection. In Spain, real life use of preventive therapies seems to be heterogeneous. We aimed to evaluate differences in clinical practice and adherence to national guidelines among Spanish neurologists.MethodsObservational descriptive study. A survey was conducted among neurologists ascribed to the Spanish Society of Neurology. Participants were differentiated in accordance with their dedication to headache disorders. We analysed socio-demographic parameters and evaluated 43 questions considering migraine management as well as therapeutic choices regarding migraine sub-types and finally, neurologists’ personal perception.ResultsOne hundred fifty-five neurologists participated from 17 different regions, 43.4% of them female and 53.3% under 40 years of age. 34.9% confirmed headache disorders as their main interest.The first choice for preventive therapy in chronic migraine among participants was topiramate (57%) followed by amytriptiline (17.9%) and beta-blockers (14.6%). However in episodic migraine, the preferred options were beta-blockers (47.7%), topiramate (21.5%) and amytriptiline (13.4%). Regarding perceived efficacy, topiramate was considered the best option in chronic migraine (42.7%) followed by onabotulinumtoxinA (25.5%) and amitryptiline (22.4%). Where episodic migraine was concerned, surveyed neurologists perceived topiramate (43.7%) and beta-blockers (30.3%) as the best options. When we evaluated the duration of treatment use with a view to adequate therapeutic response, 43.5% of neurologists preferred 3 months duration and 39.5% were in favour of 6 months duration in episodic migraine. However, considering the preferred duration of treatment use in chronic migraine, 20.4% recommended 3 months, 42.1% preferred 6 months and 12.5% and 22.4% opted for 9 and 12 months respectively. When considering onabotulinumtoxinA therapy, the number of prior therapeutic failures was zero in 7.2% of neurologists, one in 5.9%, two in 44.1%, three in 30.9% and four or more in 11.9%. Following an initial treatment failure with onabotulinumtoxinA, 49% of subjects decided against a second treatment. The number of OnabotA procedures before considering it as ineffective was two in 18.9% of neurologists, three in 70.8% and four in 10.4%.ConclusionsThe initial management of migraine among Spanish Neurologists is in line with most guidelines, where first choice preventative drugs are concerned. The Management of episodic migraine differed from chronic migraine, both in terms of neurologist preference and in their perceived efficacy.
Highlights
Headache is the most frequent reason for referral to outpatient neurology offices in Spain [1]
We aimed to evaluate the preferences in the management of migraine with preventive therapies, the perceived efficacy and safety of the current therapies among Spanish Neurologists
The survey analysis considered if the neurologist was a member of the Spanish Headache Study Group (SHSG) and those in whom headache disorders were their main area of interest
Summary
Headache is the most frequent reason for referral to outpatient neurology offices in Spain [1]. Headache is a common presenting complaint in neurology, migraineurs being the most common subgroup in the outpatient setting [2]. The Spanish Headache Study Group guidelines [3] recommended topiramate and beta-blockers as the first choice of preventive therapy in Episodic Migraine, followed by flunarizine, Lisinopril and candesartan. The first oral preventive option in Chronic Migraine is topiramate, followed by amitriptyline and in a third level flunarizine and beta-blockers. National guidelines differ in their recommendations and patients’ characteristics are usually taken into account in their selection. We aimed to evaluate differences in clinical practice and adherence to national guidelines among Spanish neurologists
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