Global trends in migraine care: results from the MAZE survey.

INTRODUCTION: Many patients with migraine do not consult a physician, or do not achieve adequate relief after consulting a physician because of undertreatment. The objective of the Migraine and Zomig Evaluation study was to provide insights into the management of migraine in the general population.
METHODS: In phase I, 5553 members of the general public in the UK, France, Germany, Italy, and the US were interviewed by telephone and classified according to International Headache Society criteria. The Migraine Disability Assessment Scale (MIDAS) questionnaire was used to assess the impact of migraine on work, home and social lives. In phase II, 516 patients with clinically diagnosed migraine were interviewed to assess the impact of migraine on daily life, attitudes towards migraine, perceptions of current treatments and aspirations for future treatments.
RESULTS: In phase I, the average prevalence of migraine over the five countries was 9%. Migraine posed a significant burden in terms of the impact on patients' daily lives, and attack severity and frequency. However, medical consultation rates were low; reasons for this included patients not recognising that they had migraine or having low expectations about treatment benefits. On average, only 10% of patients who had consulted a physician had been prescribed a triptan. Only 22% of participants in phase II thought that migraine did not markedly affect their lives. In each of the five countries, > or = 50% of patients required bed rest to manage migraine attacks, demonstrating the impact of migraine-related disability on patients' lives. Assessment of MIDAS scores confirmed the debilitating effect of migraine; > 50% of respondents had a MIDAS grade of III or IV, indicating moderate or severe disability. Less than one-third of patients reported that their current medication was consistently effective and only 36% were 'very satisfied' with their current therapy. High efficacy and rapid pain relief were rated as the most important attributes of migraine medications. When asked which formulation they would like to see more of, most patients chose a tablet that dissolves in the mouth without the need to take liquids.
CONCLUSIONS: These results show that migraine patients worldwide are still not receiving adequate treatment and there remains a significant unmet need in migraine care. The challenge for the future is to diagnose migraine early and offer patients effective migraine-specific therapies. Physicians particularly need to reach patients who do not realise they have migraine and those who have lapsed from care.