Poor medical care for people with migraine in Europe— evidence from the Eurolight study

DOI: https://doi.org/10.1186/s10194- 018- 0839- 1

Abstract-Summary Migraine is prevalent everywhere, and disabling.

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We analysed data from the Eurolight study on consultations and utilization of migraine-specific medications as indicators of adequacy of medical care in Europe. We recorded migraine prevalence and frequency, and utilization of medical ser-

vices and medications (acute and preventative).

Among 9247 participants (mean age 43.9 ± 13.9 years, M/F ratio 1:1.4), 3466

(37.6%) were diagnosed with migraine (definite or probable).

Of these, 1175 (33.8%) reported frequent migraine (> 5 days/month) and might

clearly expect benefit from, and therefore had need of, preventative medication.

In population-based samples, minorities of participants with migraine had seen a GP (9.5–18.0%) or specialist (3.1–15.0%), and smaller minorities received adequate treatment: triptans 3.4–11.0%, with Spain outlying at 22.4%; preventative medication (1.6–6.4% of those eligible, with Spain again outlying at 13.7%).

Proportions were greater in GP-based samples (13.6–24.5% using triptans, 4.4–9.1% on preventative medication) and among those from lay organisations (46.2–68.2% and 16.0–41.7%).

Participants with migraine who had consulted specialists (3.1–33.8%) were receiving the best care by these indicators; those treated by GPs (9.5–29.6%) fared less well, and those dependent on self-medication (48.0–84.2%) were, apparently, inadequately treated.

In wealthy European countries, too few people with migraine consult physicians, with proportionately too many of these seeing specialists, and migraine-specific medications are used inadequately even among those who do.

Extended: In population-based samples, 3.4–22.4% of participants with migraine

used triptans and 1.6–13.7% of those eligible used preventative medication.

Background From a public-health perspective, they are also among the most disabling at popula- tion level: according to the Global Burden of Disease (GBD) study, headache disor- ders collectively are the third highest cause in the world of years of healthy life lost to disability (YLDs), migraine alone being sixth (third in those aged under 50 years) [32, 91–94].

It might be expected that headache disorders would, everywhere, be considered important: as a personal medical problem by people directly affected by them, and as a public-health priority by health-care providers and health policy-makers.

Eurolight gathered data on headache disorders in a cross-sectional survey in 10 countries, which together represented >60% of the adult population (18–65 years) of the European Union (EU): Austria, France, Germany, Ireland, Italy, Lithuania, Luxembourg, Netherlands, Spain and United Kingdom (UK) [198].

Methods Enquiry into health-care utilisation entailed questions on use for headache of acute and preventative medications, consultations for headache (yes or no) with nurse, GP, neurologist or headache specialist, investigations for headache (MRI, CT, X-rays of the neck, blood tests, ophthalmic examination), and admissions (number) to hospital because of headache.

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This first identified, and separated, participants reporting headache on ≥15 days/ month, of whom additional questions had enquired into frequency of acute medica- tion use.

Probable medication-overuse headache (pMOH) was diagnosed when, in addi- tion, simple analgesics were used on ≥15 days/month or medication including com- pound analgesics, opioids, triptans and/or ergots was taken on ≥10 days/month.

We selected the following as indicators of adequacy of care: (a) proportion receiv- ing migraine-specific acute medications (triptans); (b) proportion of those clearly eligible receiving any preventative medication; (c) proportions receiving medical care through GP or specialist (neurologist or specialist in headache medicine).

Results The ranges were, for triptans, 3.4–68.2% of all participants with migraine and, for preventative medications, 1.6–41.7% of those deemed clearly eligible for them.

In population-based samples, 3.4–22.4% of participants with migraine used trip-

tans and 1.6–13.7% of those eligible used preventative medication.

Participants with migraine who had consulted specialists (2.1–33.8% across all studies) were receiving the best care by these indicators; those treated by GPs (9.5–29.6%) fared less well, and the larger numbers dependent on self-medication (48.0–84.2%) appeared to be inadequately treated.

In the studies with a general-population basis, a minority of participants (15.8–33.0%) had done so: 3.1–15.0% had consulted a specialist (averaged across countries: 6.8%), and 9.5–18.0% had seen a GP (average: 14.4%).

Discussion Worse, while use of preventative medication by people with >5 migraine days/ month ought by any objective standard to be close to 100%, the best we saw outside the self-selecting lay-organization members was 13.7%, and this was in an employee group with, probably, facilitated access to care.

In Germany, in three regions of the country, a population-based study of 10,000 people found only 8% of those with migraine used triptans and only 2.3% received preventative treatment, both positively associated with socio-economic status [511] and suggesting inequitable access to health care.

In order to relieve an otherwise insupportable load on specialists, health-care providers in general and GPs in particular need better knowledge of how to recog- nise, diagnose and treat migraine (along with the small number of other headache disorders that are of public-health importance) [178, 512].

Conclusion These findings represent yet another call for action in Europe to improve care for people with headache.

Acknowledgement A machine generated summary based on the work of Katsarava, Zaza; Mania, Maka; Lampl, Christian; Herberhold, Johanna; Steiner, Timothy J. 2018  in The Journal of Headache and Pain.

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Characteristics of Patients Referred to a Specialized Headache Clinic