Simona Sacco1,2, Christian Lampl3, Antoinette Maassen van den Brink4, Valeria Caponnetto5,6, Mark Braschinsky7, Anne Ducros8, Patrick Little9, Patricia Pozo-Rosich10,11, Uwe Reuter12, Elena Ruiz de la Torre9, Margarita Sanchez Del Rio13, Alexandra J Sinclair14,15, Paolo Martelletti16,17, Zaza Katsarava18,19,20,21. 1. Neuroscience section - Department of Biotechnological and Applied Clinical Sciences and (Edificio Coppito 2), University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy. simona.sacco@univaq.it. 2. Regional Referral Headache Center of the Abruzzo Region, ASL Avezzano-Sulmona-L'Aquila, L'Aquila, Italy. simona.sacco@univaq.it. 3. Department of Neurology, Headache Medical Centre Linz, Hospital Barmherzige Brüder, Centre of Integrative Medicine (ZiAM) Ordensklinikum Linz, Linz, Austria. 4. Division of Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands. 5. Neuroscience section - Department of Biotechnological and Applied Clinical Sciences and (Edificio Coppito 2), University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy. 6. Regional Referral Headache Center of the Abruzzo Region, ASL Avezzano-Sulmona-L'Aquila, L'Aquila, Italy. 7. Headache Clinic, Department of Neurology, Tartu University Clinics, Tartu, Estonia. 8. Headache Unit, Neurology Department, Montpellier University Hospital and Montpellier University, Montpellier, France. 9. European Migraine & Headache Alliance (EMHA), Brussels, Belgium. 10. Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain. 11. Headache and Neurological Pain Research Group, Department de Medicina, Universitat Autònoma de Barcelona, Vall d'Hebron Research Institute, Barcelona, Spain. 12. Charité Universitätsmedizin Berlin, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany. 13. Neurology Department, Clinica Universidad de Navarra, Madrid, Spain. 14. Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. 15. Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK. 16. Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy. 17. Regional Referral Headache Center of the Lazio Region, Sant'Andrea Hospital, Rome, Italy. 18. Christian Hospital, Unna, Germany. 19. Department of Neurology, University of Duisburg-Essen, Essen, Germany. 20. EVEX Medical Corporation, Tbilisi, Georgia. 21. IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
Abstract
BACKGROUND: 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. METHODS: We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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 migrainepatients 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. METHODS: We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. RESULTS: 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) migrainepatients; confidence in treating resistant and refractory migrainepatients 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. CONCLUSIONS: 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.
Authors: Bianca Raffaelli; Rea Kalantzis; Jasper Mecklenburg; Lucas Hendrik Overeem; Lars Neeb; Astrid Gendolla; Uwe Reuter Journal: Front Neurol Date: 2020-05-28 Impact factor: 4.003
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Authors: Bamidele Victor Owoyele; Roi Treister; Télesphore Benoît Nguelefack; Daniel Ciampi De Andrade Journal: Front Neurol Date: 2022-09-08 Impact factor: 4.086
Authors: Raffaele Ornello; Carlo Baraldi; Fayyaz Ahmed; Andrea Negro; Anna Maria Miscio; Antonio Santoro; Alicia Alpuente; Antonio Russo; Marcello Silvestro; Sabina Cevoli; Nicoletta Brunelli; Fabrizio Vernieri; Licia Grazzi; Luca Pani; Anna Andreou; Giorgio Lambru; Ilaria Frattale; Katharina Kamm; Ruth Ruscheweyh; Marco Russo; Paola Torelli; Elena Filatova; Nina Latysheva; Anna Gryglas-Dworak; Marcin Straburzyński; Calogera Butera; Bruno Colombo; Massimo Filippi; Patricia Pozo-Rosich; Paolo Martelletti; Simona Guerzoni; Simona Sacco Journal: Int J Environ Res Public Health Date: 2022-09-02 Impact factor: 4.614