The authors said their study shows that implementing migraine guidelines into day-to-day clinical practice needs improvement.
Migraine continues to be a common and disabling disorder for millions of patients. A recent study from Europe suggests that there is a discrepancy in therapy management of patients with migraine, emphasizing the need for adherence to national and international guidelines in order to improve patient outcomes.
Researchers collected data about patients with migraine using standardized questionnaires at their outpatient clinic in Germany. The questionnaire assessed headache, diagnostics, experience with previous treatments, and the efficacy of a treatment from the researchers’ center. The study also documented consecutive consultations in order to record adherence to medical advice and treatment.
“Our outpatient clinic is specifically designed to be consulted by patients in whom the general practitioner or other experts such as neurologists ask for a second opinion or a therapy optimization, however also self-referrals by patients are possible and not separately counted,” the researchers noted about their clinic. “We usually recommend adjusting therapies in accordance to the national German guideline for the acute and preventative treatment of migraine, with a focus on implementing pharmacological and non-pharmacological treatment regimens.”
The results involved data from between 2010 and 2018 with 1935 complete data sets. Twelve months prior to consulting the researchers’ clinic, 89.5% of patients had consulted a general practitioner and 74.9% had consulted a neurologist due to their migraine. Of these patients, 50% underwent unnecessary diagnostics and 34.2% had not been treated according to evidence-based treatment guidelines.
In addition, of 1031 patients who had not been prescribed a preventative treatment, 60.8% had an average of 3 or more migraine attacks per month and therefore qualified for a preventative treatment. Also, these patients had missed an average of 5 work or school days in the 3 months before their consultation. It was noted that a preventative treatment was effective in 71.2% of patients that provided follow-up data.
“This study shows the importance to better implement treatment guidelines into day-to-day clinical practice. Additionally, headache education should play a larger role in medical school for young doctors,” concluded the authors. “It is the authors’ experience in teaching headache to students, that despite its relevance, headache only plays a minor role in the curricula.”
The study emphasized that further research is necessary to investigate why adherence to guidelines in daily clinical practice is low and what factors play a role in whether clinicians are aware of the guidelines.
Ziegeler C, Brauns G, et al. Shortcomings and missed potentials in the management of migraine patients - experiences from a specialized tertiary care center [published online August 1,2019]. J Headache Pain. doi.org/10.1186/s10194-019-1034-8.