Fitzek Mira Pauline, Overeem Lucas Hendrik, Ulrich Marlene, Hong Ja Bin, Hoehne Carolin Luisa, Lange Kristin Sophie, Salim Yones, Reuter Uwe, Raffaelli Bianca
Department of Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
Junior Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany.
J Headache Pain. 2025 Apr 14;26(1):78. doi: 10.1186/s10194-025-02027-x.
Migraine significantly impairs quality of life, reduces workplace productivity, and imposes a substantial socio-economic burden. The severity of migraine correlates with its impact on quality of life and healthcare costs, emphasizing the need for adequate management. In the past, primary care services often faced issues of inadequate treatment. This study evaluates differences in pharmacological recommendations for acute and preventive migraine treatments across primary, secondary, and tertiary care settings.
This cross-sectional study involves patients with confirmed migraine (with or without aura) visiting the tertiary headache center at Charité Berlin between 12/2015 and 01/2023 for the first time. Data on headache characteristics and prior treatments for acute and prophylactic treatments at primary/secondary and recommendations from tertiary level of care were retrieved from medical letters written after first consultation.
Among 1,047 migraine patients (42 years, 84% women), 99% had received treatment for acute migraine attacks by primary/secondary care facilities, and 96% were using it at their first consultation, with 63% advised to use a triptan. The average number of triptans tested prior to referral was 1 ± 0.99. Prophylactic treatment was prescribed to 52% of patients by primary/secondary care facilities, with an average of 1.2 ± 1.6 prior prophylactic attempts per patient, and 44% were actively using it at the time of consultation. More than two thirds of patients with over four monthly migraine days were not using prophylactic treatment at referral. Tricyclic antidepressants, beta-blocker and, anticonvulsants were prescribed significantly more often in primary/secondary care settings while Onabotulinumtoxin-A and Calcitonin Gene-Related Peptide(-receptor) antibodies were more commonly initiated in tertiary care. Treatment recommendations from primary/secondary settings were revised in 77% of patients following consultation at the tertiary headache clinic.
Compared to previous studies, the overall prescription of acute and prophylactic therapies in primary and secondary care facilities has improved. Further progress is needed in expanding the range of triptans and prophylactic treatments tested before referring patients to specialized centers. However, given the selected study population, the findings may not be fully applicable to all patients treated in primary/secondary care, especially those already receiving adequate care without being referred to specialized settings.
偏头痛严重损害生活质量，降低工作场所生产力，并带来巨大的社会经济负担。偏头痛的严重程度与其对生活质量和医疗费用的影响相关，这凸显了进行充分管理的必要性。过去，初级保健服务常常面临治疗不足的问题。本研究评估了初级、二级和三级医疗机构在急性和预防性偏头痛治疗的药物推荐方面的差异。
这项横断面研究纳入了2015年12月至2023年1月期间首次前往柏林夏里特医院三级头痛中心就诊的确诊偏头痛患者（有或无先兆）。从首次会诊后撰写的医疗记录中获取头痛特征以及初级/二级医疗机构针对急性和预防性治疗的既往治疗情况和三级医疗机构的推荐意见。
在1047例偏头痛患者（平均年龄42岁，84%为女性）中，99%的患者曾在初级/二级医疗机构接受过急性偏头痛发作的治疗，96%的患者在首次会诊时正在使用相关治疗，其中63%的患者被建议使用曲坦类药物。转诊前平均试用曲坦类药物的次数为1±0.99次。初级/二级医疗机构为52%的患者开具了预防性治疗药物，每位患者平均有1.2±1.6次既往预防性治疗尝试，44%的患者在会诊时正在积极使用预防性治疗药物。超过三分之二每月偏头痛发作天数超过4天的患者在转诊时未使用预防性治疗。在初级/二级医疗机构中，三环类抗抑郁药、β受体阻滞剂和抗惊厥药的处方开具更为频繁，而A型肉毒毒素和降钙素基因相关肽（受体）抗体在三级医疗机构中更常开始使用。在三级头痛诊所会诊后，77%的患者的初级/二级医疗机构的治疗建议得到了修订。
与以往研究相比，初级和二级医疗机构在急性和预防性治疗的总体处方方面有所改善。在将患者转诊至专科中心之前，在扩大曲坦类药物和预防性治疗的试用范围方面仍需进一步改进。然而，鉴于所选的研究人群，这些发现可能并不完全适用于所有在初级/二级医疗机构接受治疗的患者，尤其是那些已经接受了充分治疗而未被转诊至专科机构的患者。
