Burden of migraine and unmet needs from the patients’ perspective: a survey across 11 specialized headache clinics in Korea

DOI: https://doi.org/10.1186/s10194- 021- 01250- 6

Abstract-Summary Migraine is a neurological, primary headache disorder affecting more than 1 billion people worldwide, with a multi-faceted burden that can significantly impact the everyday life of a patient, both during and between attacks.

Studies on patient awareness, burden, and clinical management of migraine in

Korea are limited and outdated.

A total of 207 patients with episodic or chronic migraine aged between 15 and 76 years, completed a survey designed to cover the following topics: diagnosis, understanding of the disease, treatment experience, disability, and quality of life.

Validated scales such as the Migraine Disability Assessment (MIDAS) question- naire and Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQv2.1) were used to assess levels of disability and quality of life, respectively, in patients.

High levels of disability and poor quality of life were reported by patients, as assessed by MIDAS and MSQv2.1, respectively, but only 23.7% had regularly taken preventive medication in the past.

Korean patients with migraine experience significant disability and reduced quality of life as a result of the disease and have clear unmet needs in terms of diag- nosis, understanding of the disease, and disease management including treatment.

Extended: Migraine is a disabling, neurological disease that can severely impact every aspect of an individual’s life, yet is still under-recognized, under-diagnosed, and under-treated [250].

Background Migraine and the accompanying symptoms can be significantly burdensome to patients, impacting daily functioning ability and quality of life both during and between migraine attacks [131, 138, 164, 251, 252].

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Personal and Societal Burden

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A recent study on sex differences in migraine prevalence among Korean patients showed that in women, prevalence is highest in the 30–39 age group followed by 40–49 [253].

Studies in East Asia, including South Korea, have demonstrated that migraine is

associated with a significant burden for patients.

There are unmet needs for East Asian patients in relation to diagnosis and treat- ment, owing in part to lack of the following: sufficient and appropriate diagnosis, disease awareness, and use of prescription medication [254–257].

The available literature on patient awareness, burden, and clinical management

of migraine in Korea is limited and outdated.

A survey was designed to comprehensively investigate the more current difficul- ties and unmet needs that Korean patients face regarding migraine diagnosis, aware- ness, treatment, and their perceived disability and quality of life.

Materials and Methods The survey was created in collaboration with Hankook Research Ltd. and included questions on the following in relation to migraine specifically: history and diagno- sis, knowledge about migraine, utilization of medical services, disability and qual- ity of life, unmet treatment needs regarding disease management, and experience with preventive and acute medications prior to visiting their current hospital.

Validated scales such as the Migraine Disability Assessment (MIDAS) question- naire [141] and the Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQv2.1) [156] were used to assess the level of disability and quality of life of patients, respectively.

The MSQv2.1 measures quality of life among migraine patients during the previ-

ous 4 weeks [156].

These items include; limitations of patients’ performance of normal activities (for RR), interruptions of patients’ performance of normal activities (for RP) and impact of migraine on the respondents’ emotions, such as frustration or helpless- ness (for EF).

Higher scale scores indicate better migraine-related quality of life [258].

Results The vast majority were female, mean age of onset of migraine was 27.7 years, and mean time from first symptoms to diagnosis was 10.1 years.

Representation of these data by MIDAS grade rather than age group revealed that those in MIDAS grades III and IV had reported the highest mean number of hospitals visited (4.4 [SE = 1.3] and 4.1 [SE = 0.4], respectively), compared with those in grades I and II (2.1 [SE = 0.5] and 3.3 [SE = 1.6], respectively).

Patients spent on average 1,432,500 Korean Won a year on medication for

migraine, with those over 60 spending notably less than other age groups.

Approximately one-third of patients overall were satisfied with the doctor-patient relationship in previous hospitals, with notably less satisfaction in the 50–59 group compared with other age groups.

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Discussion The results of this recent survey demonstrate that there are significant issues and unmet needs for Korean patients with migraine regarding diagnosis, awareness, and treatment.

The respondent population were patients in specialized headache clinics, which

could not be fully representative of those with migraine in the general population.

The diagnostic criteria of migraine in the ICHD appear straightforward and clear, however, due to the diversity of migraine symptoms among patients and among attacks for an individual patient, some physicians are unsure of the diagnosis of migraine.

A study has shown that only 13% of Korean patients with migraine have aura

symptoms [259].

As reported in other studies including analyses in Asian countries [137, 255, 260–262], there are clear unmet preventive treatment needs for Korean patients with migraine, particularly for those in most need of them.

Conclusion The results of our survey confirm the significant burden that Korean patients with migraine experience and the critical unmet needs with regards to diagnosis and treatment.

Patient-centric intervention to reduce the diagnostic lag, increase awareness and understanding of migraine, optimize the use of medical services, enhance doctor- patient relationships and the management of migraine should be implemented to alleviate the burden of migraine.

Acknowledgement A machine generated summary based on the work of Kim, Byung-Kun; Chu, Min Kyung; Yu, Soo Jin; Dell’Agnello, Grazia; Han, Jeong Hee; Cho, Soo-Jin. 2021 in The Journal of Headache and Pain.

The Headache-Attributed Lost Time (HALT) Indices: measures of burden for clinical management and population-based research