Migraine practice patterns among neurologists

Lipton, Richard B.; Bigal, ME; Rush, Steven R.; Yenkosky, J. P.; Liberman, Joshua N.; Bartleson, J. D.; Silberstein, Stephen D.

doi:10.1212/wnl.62.11.1926

Cited by 47 publications

(41 citation statements)

References 17 publications

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“…Maybe reflecting this fact is the observation that most physicians in this sample have quite adequate and realistic perceptions about migraine - the vast majority (96%) considered migraine a disease (in accordance with the French study [22] yet contrasting with an American study [23]), 65% recognize that the majority of patients do not consult for migraine [10,24], 87% recognize the need of a schedule for follow-up visits for migraine patients and report realistic expectations about acute and preventive treatment outcomes. In our sample the low interest in migraine negatively influenced the perception of its disability but not the perception of migraine as a disease.…”

Section: Discussionmentioning

confidence: 73%

Headache from the Doctors' Perspective

Gil‐Gouveia¹

2014

Eur Neurol

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Background: General practitioners (GPs) and neurologists are involved in treating headache patients in Portugal. Having migraine themselves might influence the way they perceive and treat migraine patients. Objective: To identify clinicians' perceptions about migraine, their own headache status and management of their own migraine. Methods: An observational cross-sectional survey of GPs and neurologists using anonymous questionnaires including demographic data, headache and migraine status and migraine perception questions. Results: Of 348 respondent physicians, 20% were neurologists and 53% were females with an average age of 48 years. The majority had an interest in migraine and considered it disabling (93%), although 65-85% reported management difficulties, GPs more often than neurologists. Satisfaction with current treatment options was high (69-79%). 63 physicians suffered from migraine and 81% felt it influenced their perception of the disease. Portuguese physicians preferentially treat their own migraines with NSAIDs (33%), analgesics (29%) and triptans (20%). Conclusion: Portuguese physicians treating migraine patients have realistic perceptions about the disease and those with migraine feel their perception is influenced by their experience. Although reporting management difficulties, the majority of physicians are satisfied with current treatment options for migraine.

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Section: Discussionmentioning

confidence: 73%

Headache from the Doctors' Perspective

Gil‐Gouveia¹

2014

Eur Neurol

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“…In contrast, when researchers used open-ended questions during the post-visit interviews, patients often revealed information focused on impairment that was not disclosed during the visit 25,[40][41][42][43][44] . These detailed, emotional responses provided a more complete and compelling picture of how disabling migraines really are for the patient.…”

Section: Resultsmentioning

confidence: 99%

In-office Discussions of Migraine: Results from the American Migraine Communication Study

et al. 2008

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BACKGROUND:Research indicates that successful migraine assessment and treatment depends on information obtained during patient and healthcare professional (HCP) discussions. However, no studies outline how migraine is actually discussed during clinical encounters. OBJECTIVE:Record naturally occurring HCP-migraineur interactions, analyzing frequency and impairment assessment, and preventive treatment discussions. DESIGN:HCPs seeing high volumes of migraineurs were recruited for a communication study. Patients likely to discuss migraine were recruited immediately before their normally scheduled appointment and, once consented, were audio-and video-recorded without a researcher present. Separate post-visit interviews were conducted with patients and HCPs. All interactions were transcribed.PARTICIPANTS: Sixty patients (83% female; mean age 41.7) were analyzed. Patients were diagnosed with migraine 14 years and experienced 5 per month, on average.APPROACH: Transcripts were analyzed using sociolinguistic techniques such as number and type of questions asked and post-visit alignment on migraine frequency and impairment. American Migraine Prevalence and Prevention Study guidelines were utilized.RESULTS: Ninety-one percent of HCP-initiated, migraine-specific questions were closed-ended/short answer; assessments focused on frequency and did not focus on attention on impairment. Open-ended questions in patient post-visit interviews yielded robust impairment-related information. Post-visit, 55% of HCP-patient pairs were misaligned regarding frequency; 51% on impairment. Of the 20 (33%) patients who were preventive medication candidates, 80% did not receive it and 50% of their visits lacked discussion of prevention.CONCLUSIONS: Sociolinguistic analysis revealed that HCPs often used narrowly focused, closed-ended questions and were often unaware of how migraine affected patients' lives as a result. It is recommended that HCPs assess impairment using open-ended questions in combination with the ask-tell-ask technique.

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“…The class of medications that is closer to reach the market and will likely be available over the near future is the calcitonin gene receptor peptide (CGRP) antagonist. CGRP levels in external jugular venous blood are elevated during migraine and cluster headache attacks and, as in animal models of trigeminal stimulation to be normalized by successful anti-migraine drug therapy with sumatriptan 74,75 . Intravenous administration of CGRP has been shown to trigger a migraine-like headache in migraineurs.…”

Section: Future Developments For the Acute Treatment Of Migraine -Thementioning

confidence: 99%

“…First, triptans are largely underutilized, especially by primary care doctors who are worried about their potential constrictive effects 74 . second, up to 30-40% of patients in clinical trials do not response to triptans.…”

Section: Future Developments For the Acute Treatment Of Migraine -Thementioning

confidence: 99%

Migraine in the triptan era: progresses achieved, lessons learned and future developments

Bigal

Krymchantowski²,

2009

Arq. Neuro-Psiquiatr.

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-Triptans, serotonin 5-HT 1B/1D receptor agonists, more than revolutionizing the treatment of migraine, stimulated also ground breaking research that provided insights into the anatomy, physiology, and molecular pharmacology of migraine. This knowledge, in turn, is stimulating research on new mechanisms of action for the treatment of migraine. Accordingly, it is opportune to critically review the main advances in migraine science that happened in the triptan era. Herein we first review and conceptualize some of the progresses achieved in migraine science during the triptan era. We then review the class of the triptans -mechanism of action and clinical evidence. We close by briefly discussing the class of CGRP receptor antagonists, which is currently being developed for the acute treatment of migraine.Key WoRDs: migraine, triptans, CGRP antagonists, emerging drugs.Migrânea na era dos triptanos: progressos alcançados, lições aprendidas e desenvolvimentos futuros resumo -os triptanos, agonistas serotoninérgicos 5-HT 1B/1D , revolucionaram o tratamento da migrânea promovendo pesquisas que evidenciaram aspectos da anatomia, fisiologia e farmacologia molecular deste tipo prevalente de cefaléia primária. esse conhecimento, por sua vez vem estimulando ainda mais a descoberta de novos mecanismos de ação para drogas anti-migranosas. Assim, é oportuno rever de forma crítica, os maiores avanços na ciência das cefaléias ocorridos durante a era dos triptanos. Inicialmente reveremos e conceituaremos alguns dos progressos obtidos nesta fase seguido de uma revisão profunda dos mecanismos de ação e evidências clínicas para o uso desta classe de fármacos. Finalmente, discutiremos a nova classe dos antagonistas dos receptores do peptideo geneticamente relacionado à calcitonina (CGRP) atualmente em desenvolvimento. Migraine is a chronic neurological disorder characterized by episodic attacks of headache and associated symptoms 1 . Attempts to alleviate the suffering caused by migraine span millennia and encompass treatments as primitive as trepanation of the skull, to increasingly specific medications that act on receptor subtypes implicated in the pathophysiology of migraine 2 . Triptans, serotonin 5-HT 1B/1D receptor agonists, more than revolutionizing the treatment of migraine, stimulated also ground breaking research that provided insights into the anatomy, physiology, and molecular pharmacology of migraine 3 . This knowledge, in turn, is stimulating research on new mechanisms of action for the treatment of migraine. Accordingly, it is opportune to critically review the main advances in migraine science that happened in the triptan era. To do so, we divided this views and reviews in two main components. We first review and conceptualize some of the progresses achieved in migraine science during the triptan era. We focus on selective themes, and for each, we briefly discuss the established concept (status quo), as well as the evolving knowledge on the area. We then review the class of the triptans -mechanism of action an...

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Migraine practice patterns among neurologists

Cited by 47 publications

References 17 publications

Headache from the Doctors' Perspective

Headache from the Doctors' Perspective

In-office Discussions of Migraine: Results from the American Migraine Communication Study

Migraine in the triptan era: progresses achieved, lessons learned and future developments

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