Burden and attitude to resistant and refractory migraine : a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance
Sacco, Simona (ASL Avezzano-Sulmona-L'Aquila)
Lampl, Christian (Hospital Barmherzige Brüder)
Maassen van den Brink, Antoinette (Erasmus MC University Medical Center Rotterdam)
Caponnetto, Valeria (ASL Avezzano-Sulmona-L'Aquila)
Ducros, Anne (University Hospital of Montpellier (França))
Little, Patrick (European Migraine & Headache Alliance (EMHA), Brussels)
Pozo-Rosich, Patricia (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Reuter, Uwe (Charité - Universitätsmedizin Berlin)
Ruiz de la Torre, Elena (European Migraine & Headache Alliance (EMHA), Brussels)
Sánchez Del Rio, Margarita (Clínica Universidad de Navarra)
Sinclair, Alexandra J. (Birmingham Health Partners)
Martelletti, Paolo (Sant'Andrea Hospital)
Katsarava, Zaza (IM Sechenov First Moscow State Medical University)
Universitat Autònoma de Barcelona

Data:	2021
Resum:	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. We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. 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. 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. The online version contains supplementary material available at 10. 1186/s10194-021-01252-4.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Migraine ; Resistant migraine ; Refractory migraine ; Migraine care
Publicat a:	Journal of headache and pain, Vol. 22 (may 2021) , ISSN 1129-2377

DOI: 10.1186/s10194-021-01252-4
PMID: 34006218

10 p, 2.3 MB

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