Piero Barbanti1,2, Luisa Fofi1, Licia Grazzi3, Fabrizio Vernieri4, Cecilia Camarda5, Paola Torelli6,7, Sabina Cevoli8, Antonio Russo9, Francesco Bono10, Cinzia Finocchi11, Renata Rao12, Stefano Messina13, Roberto De Simone14, Nicola Vanacore15, Stefano Bonassi16. 1. Headache and Pain Unit, IRCCS San Raffaele Pisana, Rome, Italy. 2. San Raffaele University, Rome, Italy. 3. Neuroalgology Unit, Headache Center Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy. 4. Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy. 5. Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy. 6. Department of Medicine and Surgery, University of Parma, Parma, Italy. 7. Headache Center, Unit of Neurology, Azienda Ospedaliera-Universitaria of Parma, Parma, Italy. 8. IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy. 9. Headache Center, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy. 10. Headache Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy. 11. IRCCS Ospedale Policlinico San Martino, Genova, Italy. 12. Headache Center, Department of Neurological Sciences and of Vision, Spedali Civili, Brescia, Italy. 13. Department of Neurology-Stroke Unit, Laboratory of Neuroscience, Istituto Auxologico Italiano, IRCCS, Milano, Italy. 14. Headache Center, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, Naples, Italy. 15. National Centre for Disease Prevention and Health Promotion, National Institute of Health, Roma, Italy. 16. Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Roma, Italy.
Abstract
OBJECTIVE: To develop a dedicated Italian chronic migraine (CM) database (IRON project) to overcome disease misconceptions, improve clinical administration, reduce patients' burden, and rationalize economic resource allotment. BACKGROUND: Proper CM management requires a comprehensive appraisal of its full clinical, social, and economic complexity. METHODS: In this cross-sectional study, CM patients were screened in 24 certified headache centers with face-to-face interviews. Information on sociodemographic factors, medical history, characteristics of CM, and of prior episodic migraine (EM), and healthcare resource use was gathered using a semistructured web-based questionnaire. RESULTS: A total of 866 CM patients were enrolled. CM started ~20 years after EM onset (age at EM onset 17.4 ± 9.1 vs. age at CM onset 35.3 ± 12.5 [mean ± SD]). CM prophylaxis, used by 430/866 (49.6%) of the patients, was often ineffective, not tolerated, and prematurely discontinued. Medications and diagnostic workup, frequently inappropriate, were mostly subsidized by the Italian national health service. CM patients with ≥25 headache days/month revealed substantial clinical differences and heavier disability and economic burden compared with those with <25 headache days/month. CONCLUSIONS: CM is a heterogeneous headache disorder deserving more in-depth clinical characterization, sharper diagnostic criteria, and tailored treatments. CM registries are expected to improve clinical management, resulting in increased disease awareness, better healthcare resource allocation, and reduced economic burden.
OBJECTIVE: To develop a dedicated Italian chronic migraine (CM) database (IRON project) to overcome disease misconceptions, improve clinical administration, reduce patients' burden, and rationalize economic resource allotment. BACKGROUND: Proper CM management requires a comprehensive appraisal of its full clinical, social, and economic complexity. METHODS: In this cross-sectional study, CM patients were screened in 24 certified headache centers with face-to-face interviews. Information on sociodemographic factors, medical history, characteristics of CM, and of prior episodic migraine (EM), and healthcare resource use was gathered using a semistructured web-based questionnaire. RESULTS: A total of 866 CM patients were enrolled. CM started ~20 years after EM onset (age at EM onset 17.4 ± 9.1 vs. age at CM onset 35.3 ± 12.5 [mean ± SD]). CM prophylaxis, used by 430/866 (49.6%) of the patients, was often ineffective, not tolerated, and prematurely discontinued. Medications and diagnostic workup, frequently inappropriate, were mostly subsidized by the Italian national health service. CM patients with ≥25 headache days/month revealed substantial clinical differences and heavier disability and economic burden compared with those with <25 headache days/month. CONCLUSIONS: CM is a heterogeneous headache disorder deserving more in-depth clinical characterization, sharper diagnostic criteria, and tailored treatments. CM registries are expected to improve clinical management, resulting in increased disease awareness, better healthcare resource allocation, and reduced economic burden.