The practice patterns of migraine management among neurologists in the Philippines - A cross-sectional survey

Abstract

Objectives: We aimed to describe the current preferences of Filipino neurologists in the diagnosis and management of migraine. Methods: This is an observational descriptive study using a web-based survey done from November 2019 to June 2020 among certified locally practicing neurologists belonging to the Philippine Neurological Association. Results: A total of 259 (56.67%) from the 2018 roster of 457 neurologists participated in the survey. The prevalence of migraine in the respondents was 49.81% with a F:M ratio of 3.3:1. The majority (78%) based their diagnosis on established international criteria for migraine. Many (77%) would request neuroimaging for their patients with a history of more than 3 years of recurrent severe migraine. The most preferred class of drugs for acute migraine was NSAIDs (48.26%). One-third of respondents would give anti-nausea medications for moderate to severe attacks of migraine. About half would not consider using triptans for their patients with moderate to severe episodic migraine attacks. The top three drugs used for migraine prophylaxis were topiramate (80.69%) followed by flunarizine (73.36%) and propranolol (49.03%). Among patients with two or more headaches per week, 74.13% would prescribe prophylactic drugs. The use of a headache diary and the Migraine Disability Assessment Scale (MIDAS) was advised by 62.16% and 14.67% of respondents respectively, while cautioning about medication overuse headache was done by 68.34%. Conclusions: We have described the preferred practice of Filipino neurologists in diagnosing and treating migraine patients with locally available resources. The use of measurement tools (specifically MIDAS scoring to assess migraine disability), triptans, and anti-nausea drugs are not popular practices among Filipino neurologists The survey shows the need to promote the use of prophylactic drugs, counselling for medication overuse and more teaching about primary headaches in medical school.