Neurology Department, Headache Unit, Hospital ClínicoUniversitario, Valladolid, Spain.
Department of Medicine, University of Valladolid, Valladolid, Spain.
BMC Fam Pract. 2021 Mar 20;22(1):54. doi: 10.1186/s12875-021-01402-2.
Migraine affects 80.8 million people in Western Europe and is the first cause of disability among people between ages 15 and 49 worldwide. Despite being a highly prevalent and disabling condition, migraine remains under-diagnosed and poorly managed.
An international, online survey was conducted among 201 general practitioners (GPs) from 5 European countries (France, Germany, Italy, Spain and the UK) who are experienced in the management of headache disorders.
The majority of GPs (82%) did not refer patients with chronic migraine (CM) to migraine specialists. Among those patients, the participants estimated that around 55% received preventive medication. Some differences between countries were observed regarding referral rate and prescription of preventive treatment. Most GPs (87%) reported a lack of training or the need to be updated on CM management. Accordingly, 95% of GPs considered that a migraine anamnesis guide could be of use. Overall, more than 95% of GPs favoured the use of a patient diary, a validated diagnostic tool and a validated scale to assess impact of migraine on patients' daily life. Similarly, 96% of the GPs considered that the inclusion of warning features (red flags) in an anamnesis guide would be useful and 90% favoured inclusion of referral recommendations.
The results from this survey indicate that more education on diagnosis and management of CM is needed in primary care. Better knowledge on the recognition and management of migraine in primary care would improve both prognosis and diagnosis and reduce impact of migraine on patients' lives, healthcare utilization and societal burden.
偏头痛影响了西欧的 8080 万人，是全世界 15 至 49 岁人群残疾的首要原因。尽管偏头痛是一种高发且致残的疾病，但它的诊断率仍然较低，管理也较差。
在来自法国、德国、意大利、西班牙和英国 5 个欧洲国家的 201 名经验丰富的头痛疾病管理的全科医生中开展了一项国际在线调查。
大多数（82%）全科医生不会将慢性偏头痛（CM）患者转介给偏头痛专家。在这些患者中，参与者估计约有 55%接受了预防性药物治疗。在转诊率和预防性治疗的处方方面观察到一些国家之间的差异。大多数（87%）全科医生报告缺乏 CM 管理方面的培训或需要更新培训。因此，95%的全科医生认为偏头痛病史指南可能会有用。总体而言，超过 95%的全科医生赞成使用患者日记、经过验证的诊断工具和评估偏头痛对患者日常生活影响的经过验证的量表。同样，96%的全科医生认为在病史指南中纳入警示特征（“红色标志”）会很有用，90%的医生赞成纳入转诊建议。
这项调查的结果表明，初级保健中需要进行更多关于 CM 的诊断和管理的教育。提高初级保健中对偏头痛的识别和管理的认识，将改善预后和诊断，并减少偏头痛对患者生活、医疗保健利用和社会负担的影响。
