Ryvlin Philippe, Skorobogatykh Kirill, Negro Andrea, Sanchez-De La Rosa Rainel, Israel-Willner Heike, Sundal Christina, MacGregor E Anne, Guerrero Angel L
Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.
University Headache Clinic, Moscow, Russia.
BMC Neurol. 2021 Jan 4;21(1):1. doi: 10.1186/s12883-020-02014-6.
Migraine is a prevalent and disabling headache disorder that affects more than 1.04 billion individuals world-wide. It can result in reduction in quality of life, increased disability, and high socio-economic burden. Nevertheless, and despite the availability of evidence-based national and international guidelines, the management of migraine patients often remains suboptimal, especially for chronic migraine (CM) patients.
My-LIFE anamnesis project surveyed 201 General practitioners (GPs) from 5 European countries (France, Germany, Italy, Spain, and the UK) with the aim of understanding chronic migraine (CM) patients' management in the primary care setting.
In our survey, GPs diagnosed episodic migraine (EM) more often than CM (87% vs 61%, p < 0.001). We found that many CM patients were not properly managed or referred to specialists, in contrast to guidelines recommendations. The main tools used by primary-care physicians included clinical interview, anamnesis guide, and patient diary. Tools used at the first visit differed from those used at follow-up visits. Up to 82% of GPs reported being responsible for management of patients diagnosed with disabling or CM and did not refer them to a specialist. Even when the GP had reported referring CM patients to a specialist, 97% of them were responsible for their follow-up. Moreover, the treatment prescribed, both acute and preventive, was not in accordance with local and international recommendations. GPs reported that they evaluated the efficacy of the treatment prescribed mainly through patient perception, and the frequency of follow-up visits was not clearly established in the primary care setting. These results suggest that CM is underdiagnosed and undertreated; thereby its management is suboptimal in the primary care.
There is a need of guidance in the primary care setting to both leverage the management of CM patients and earlier referral to specialists, when appropriate.
偏头痛是一种常见且使人致残的头痛疾病，全球有超过10.4亿人受其影响。它会导致生活质量下降、残疾增加以及社会经济负担加重。然而，尽管有基于证据的国家和国际指南，但偏头痛患者的管理往往仍未达到最佳状态，尤其是慢性偏头痛（CM）患者。
“我的生活”问诊项目对来自5个欧洲国家（法国、德国、意大利、西班牙和英国）的201名全科医生（GP）进行了调查，旨在了解基层医疗环境中慢性偏头痛（CM）患者的管理情况。
在我们的调查中，全科医生诊断发作性偏头痛（EM）的频率高于慢性偏头痛（CM）（87%对61%，p < 0.001）。我们发现，与指南建议相反，许多慢性偏头痛患者没有得到妥善管理或转诊至专科医生处。基层医疗医生使用的主要工具包括临床访谈、问诊指南和患者日记。首次就诊时使用的工具与随访时使用的工具不同。高达82%的全科医生报告负责管理被诊断为致残性或慢性偏头痛的患者，且未将他们转诊至专科医生处。即使全科医生报告已将慢性偏头痛患者转诊至专科医生处，其中97%的人仍负责对其进行随访。此外，所开的急性和预防性治疗均不符合当地和国际建议。全科医生报告称，他们主要通过患者的感受来评估所开治疗的疗效，且在基层医疗环境中随访就诊的频率并未明确确定。这些结果表明，慢性偏头痛的诊断和治疗不足；因此，其在基层医疗中的管理未达到最佳状态。
在基层医疗环境中需要指导，以优化慢性偏头痛患者的管理，并在适当的时候尽早转诊至专科医生处。
