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Mingels S, Granitzer M, Luedtke K, Dankaerts W. What is the Status Quo of Patient-Centred Physiotherapy Management of People with Headache within a Biopsychosocial Model? - A Narrative Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01306-7. [PMID: 39141253 DOI: 10.1007/s11916-024-01306-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE OF REVIEW Patient-centred care (PCC) is deemed essential in the rehabilitation of musculoskeletal pain. Integrating such care within a biopsychosocial framework, enables to address all facets of the individual pain experience, and to manage the individual instead of the condition. This narrative review describes the status quo of PCC physiotherapy management of people with headache within a biopsychosocial model. PubMed, EMBASE, Web of Science, Scopus were searched (update 07.05.2024). The search-query comprised terminology relating to "headache", "patient-centred", "biopsychosocial", "physiotherapy". Additional eligibility criteria were reviews, trials, cohort, case report, case-control studies in English, Dutch, French. RECENT FINDINGS Gaps are exposed in patient-centred physiotherapy management of migraine, tension-type headache, and cervicogenic headache. While a biopsychosocial approach is advised to manage migraine and tension-type headache, its use in clinical practice is not reflected by the literature. A biopsychosocial approach is not advised in cervicogenic headache. Psychosocial-lifestyle interventions are mainly delivered by health-care providers other than physiotherapists. Additionally, psychologically-informed practice is barely introduced in physiotherapy headache management. Though, managing the social context within a biopsychosocial framework is advised, the implementation by physiotherapists is unclear. Comparable conclusions apply to PCC. PCC is recommended for the physiotherapy management of primary and secondary headache. Such recommendation remains however theoretical, not reaching clinical implementation. Yet, a shift from the traditional disease-centred model of care towards PCC is ongoing and should be continued in physiotherapy management. With this implementation, clinical and economical studies are needed to evaluate its effectiveness.
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Affiliation(s)
- Sarah Mingels
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Leuven, Belgium.
- Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium.
| | - Marita Granitzer
- Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
| | - Kerstin Luedtke
- Department of Physiotherapy, Pain and Exercise Research, Institute of Health Sciences, Universität Zu Lübeck, Zu Lübeck, Germany
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Leuven, Belgium
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Angermaier A, Koennecke A, Kloetzer C, Strauss S, Fleischmann R. Reliability of a telephone interview for the classification of headache disorders. Front Neurol 2023; 14:1238266. [PMID: 37693750 PMCID: PMC10486902 DOI: 10.3389/fneur.2023.1238266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023] Open
Abstract
Objective The study aimed to test the reliability of a semi-structured telephone interview for the classification of headache disorders according to the ICHD-3. Background Questionnaire-based screening tools are often optimized for single primary headache diagnoses [e.g., migraine (MIG) and tension headache (TTH)] and therefore insufficiently represent the diagnostic precision of the ICHD-3, which limits epidemiological research of rare headache disorders. Brief semi-structured telephone interviews could be an effective alternative to improve classification. Methods A patient population representative of different primary and secondary headache disorders (n = 60) was recruited from the outpatient clinic (HSA) of a tertiary care headache center. These patients completed an established population-based questionnaire for the classification of MIG, TTH, or trigeminal autonomic cephalalgia (TAC). In addition, they received a semi-structured telephone interview call from three blinded headache specialists individually. The agreement of diagnoses made either using the questionnaires or interviews with the HSA diagnoses was evaluated. Results Of the 59 patients (n = 1 dropout), 24% had a second-order and 5% had a third-order headache disorder. The main diagnoses were as follows: frequent primary headaches with 61% MIG, 10% TAC, 9% TTH, and 5% rare primary and 16% secondary headaches. Second-order diagnosis was chronic migraine throughout, and third-order diagnoses were medication overuse headache and TTH. Agreement between main headaches from the HSA was significantly better for the telephone interview than for the questionnaire (questionnaire: κ = 0.330; interview: κ = 0.822; p < 0.001). Second-order diagnoses were not adequately captured by questionnaires, while there was a trend for good agreement with the telephone interview (κ = 0.433; p = 0.074). Headache frequency and psychiatric comorbidities were independent predictors of HSA and telephone interview agreement. Male sex, headache frequency, severity, and depressive disorders were independently predictive for agreement between the questionnaire and HSA. The telephone interview showed high sensitivity (≥71%) and specificity (≥92%) for all primary headache disorders, whereas the questionnaire was below 50% in either sensitivity or specificity. Conclusion The semi-structured telephone interview appears to be a more reliable tool for accurate diagnosis of headache disorders than self-report questionnaires. This offers the potential to improve epidemiological headache research and care even in underserved areas.
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Gouider R, Lorenz DH, Craven A, Grisold W, Dodick DW. Advocacy for patients with headache disorders. eNeurologicalSci 2023; 31:100466. [PMID: 37250108 PMCID: PMC10209324 DOI: 10.1016/j.ensci.2023.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/07/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023] Open
Abstract
Primary headache disorders are worldwide highly prevalent and burdensome and should be therefore considered as a global public health priority. However, too many patients with primary headache disorders still do not receive satisfying care. The most likely identified reasons for such a scenario - lack of public awareness, stigma, lack of trained professionals with inadequate healthcare systems and policies - are remediable. Despite the progresses that were made in headache advocacy, these efforts have not yielded substantial improvements in research funding or access to specialty care and even standards of care. The situation is more complex in Low and Middle Income Countries (LMICs) where headache advocacy is urgently needed given the magnitude of the difficulties that patients with primary headache disorders face in accessing care. The growing emergence of coordinated, collaborative, patient-centered advocacy efforts with improved patient-clinician partnership is an opportunity to enhance progress in advocacy for a satisfying life and optimal and equitable care for people with primary headache disorders. LMICs can benefit greatly from coordinating these efforts on a global scale. The recent organization of a training program on headache diagnosis and management for healthcare professionals in Africa is a concrete example.
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Affiliation(s)
- Riadh Gouider
- Neurology Department, LR18SP03, Razi Universitary Hospital, 1 rue des orangers Manouba, 2010 Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, 1 rue des orangers Manouba, 2010 Tunis, Tunisia
| | | | - Audrey Craven
- European Federation of Neurological Associations & European Headache & Migraine Alliance, Dublin, Ireland
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria
| | - David W. Dodick
- Mayo Clinic Arizona, Chief Science Officer, Atria Academy of Science and Medicine, USA
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Sakai F, Igarashi H, Yokoyama M, Begasse de Dhaem O, Kato H, Azuma Y, Koh R, Phillips H, Singh N, Craven A, Dodick DW, Miyake H. Diagnosis, knowledge, perception, and productivity impact of headache education and clinical evaluation program in the workplace at an information technology company of more than 70,000 employees. Cephalalgia 2023; 43:3331024231165682. [PMID: 36967710 DOI: 10.1177/03331024231165682] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Migraine is a highly prevalent, disabling, misunderstood, underdiagnosed, and undertreated neurological disease. It is a leading cause of productivity loss in the workplace. METHODS This is the first large-scale company-wide headache education and evaluation program in the workplace. RESULTS 73,432 (90.5%) Fujitsu employees participated. The prevalence of migraine was 16.7%, tension-type headache 40.7%, and cluster headache 0.5%. After completing the training, 82.9% of participants without headache said they would change their attitude towards colleagues with headache disorders and 72.5% of total participants said their understanding of headache changed. The proportion of employees who thought that headache had a significant impact on people's lives increased from 46.8% to 70.6%; 2971 (4.1%) of all participants were interested in a virtual consultation with a headache specialist as part of the program, more than half of whom had not previously consulted for headache. Approximately 14.7 days per year of full productivity per employee with headache were gained resulting in an annual productivity saving per employee of US$4531. CONCLUSION This unique headache workplace program was associated with a high level of participation, an improvement in the understanding of migraine and attitude towards colleagues with migraine, reduction in disability and increased employee productivity, and decreased costs of lost productivity due to migraine. Workplace programs for migraine should be considered for all industry sectors.
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Affiliation(s)
- Fumihiko Sakai
- International Headache Society Global Patient Advocacy Coalition Executive Committee, Saitama International Headache Center, Saitama Neuropsychiatric Institute, Saitama, Japan
| | | | | | - Olivia Begasse de Dhaem
- International Headache Society Global Patient Advocacy Coalition Executive Committee, Hartford HealthCare, Westport, Connecticut, USA
| | - Hirohisa Kato
- Health Promotion Unit at Fujitsu Co. Ltd, Kawasaki, Japan
| | - Yasuhiro Azuma
- Health Promotion Unit at Fujitsu Co. Ltd, Kawasaki, Japan
| | - Rachel Koh
- International Headache Society Global Patient Advocacy Coalition Executive Committee, American Migraine Foundation, Texas, USA
| | - Heather Phillips
- International Headache Society Global Patient Advocacy Coalition Executive Committee, American Migraine Foundation, New York, USA
| | - Nim Singh
- International Headache Society Global Patient Advocacy Coalition Executive Committee, Atria Academy of Science and Medicine, New York, USA
| | | | - David W Dodick
- International Headache Society Global Patient Advocacy Coalition Executive Committee, Atria Academy of Science and Medicine, New York, USA
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Hitoshi Miyake
- Health Promotion Unit at Fujitsu Co. Ltd, Kawasaki, Japan
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Begasse de Dhaem O, Sakai F. Migraine in the workplace. eNeurologicalSci 2022; 27:100408. [PMID: 35774055 PMCID: PMC9237352 DOI: 10.1016/j.ensci.2022.100408] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/15/2022] Open
Abstract
Migraine is prevalent, disabling, and peaks during people's peak productive years. The impact of migraine on people's professional lives, work productivity, and interpersonal relationships at work eventually affects everyone, has a significant detrimental effect on people with migraine, and a huge cost in terms of lost productivity. People with migraine want to work, so they do their best to work despite the varied migraine related and associated symptoms. Most of migraine-related productivity loss (89%) is due to presenteeism. People are less than half effective during a migraine attack due to the pain, migraine symptoms, attack unpredictability, migraine comorbidities, emotional impact, under-diagnosis and under-management, and the stigma. Migraine-related productivity loss may negatively affect people's career choice, job status and/or security, financial status, work relationships, mood, and confidence. Migraine is estimated to represent 16% of total US workforce presenteeism. Thankfully, there are ways to help support people with migraine in the workplace and increase their productivity such as: workplace migraine education programs, workplace migraine education and management programs, migraine-friendly work environment, migraine treatment optimization and advocacy. The example of the successful workplace migraine education and management program developed and run in collaboration between Fujitsu, the Japanase Headache Society, and the International Headache Society Global Patient Advocacy Coalition is discussed. Migraine-related productivity loss is costly to people with migraine, to employers, and to everyone in one way or another. Workplace migraine education and/or management programs and migraine-friendly environment help people with migraine at work. Neurologists can help support their patients in the workplace and get involved in advocacy in many ways.
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Affiliation(s)
| | - Fumihiko Sakai
- Saitama International Headache Center, Saitama Neuropsychiatric Institute, Saitama, Japan
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Díaz-Insa S, Navarro-Zornoza M, Sánchez-de la Rosa R, Guerrero A. Caracterización del manejo del paciente con migraña en Atención Primaria en España. Análisis de los resultados del proyecto europeo My-LIFE anamnesis. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Thiele A, Klehr L, Strauß S, Angermaier A, Schminke U, Kronenbuerger M, Naegel S, Fleischmann R. Preventive treatment with CGRP monoclonal antibodies restores brain stem habituation deficits and excitability to painful stimuli in migraine: results from a prospective case-control study. J Headache Pain 2021; 22:149. [PMID: 34895133 PMCID: PMC8903683 DOI: 10.1186/s10194-021-01364-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/22/2021] [Indexed: 12/05/2022] Open
Abstract
Background & Objectives Calcitonin gene-related peptide ligand/receptor (CGRP) antibodies effectively reduce headache frequency in migraine. It is understood that they act peripherally, which raises the question whether treatment merely interferes with the last stage of headache generation or, alternatively, causes secondary adaptations in the central nervous system and might thus possess disease modifying potential. This study addresses this question by investigating the nociceptive blink reflex (nBR), which is closely tied to central disease activity, before and after treatment with CGRP antibodies. Methods We enrolled 22 patients suffering episodic migraine (21 female, 46.2 ± 13.8 years of age) and 22 age-/gender-matched controls. Patients received assessments of the nBR (R2 component, 10 trials, 6 stimuli/trial) before (V0) and three months (V3) after treatment with CGRP antibodies started, controls were assessed once. The R2 area (R2a) and habituation (R2h; gradient of R2a against stimulus order) of the stimulated/non-stimulated side (_s/_ns) following repeated supraorbital stimulation provide a direct readout of brainstem excitability and habituation as key mechanisms in migraine. Results All patients showed a substantial reduction of headache days/month (V0: 12.4±3.3, V3: 6.6 ± 4.9). R2a_s (Fglobal=5.86, p<0.001; block 1: R2a_s: -28%, p<0.001) and R2a_ns (Fglobal=8.22, p<0.001, block 1: R2a_ns: -22%, p=0.003) were significantly decreased, and R2h_ns was significantly enhanced (Fglobal=3.07, p<0.001; block 6: R2h_ns: r=-1.36, p=0.007) from V0 to V3. The global test for changes of R2h_s was non-significant (Fglobal=1.46, p=0.095). Changes of R2h significantly correlated with improvement of headache frequency (R2h_s, r=0.56, p=0.010; R2h_ns: r=0.45, p=0.045). None of the nBR parameters assessed at baseline predicted treatment response. Discussion We provide evidence that three months of treatment with CGRP antibodies restores brain stem responses to painful stimuli and thus might be considered disease modifying. The nociceptive blink reflex may provide a biomarker to monitor central disease activity. Future studies should evaluate the blink reflex as a clinical biomarker to predict treatment response at baseline and to establish the risk of relapse after treatment discontinuation. Trial registration This trial was prospectively registered at clinicaltrials.gov (ID: NCT04019496, date of registration: July 15, 2019).
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Affiliation(s)
- Anne Thiele
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany
| | - Lara Klehr
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany
| | - Sebastian Strauß
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany
| | - Anselm Angermaier
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany
| | - Ulf Schminke
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany
| | - Martin Kronenbuerger
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany.,University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Steffen Naegel
- Department of Neurology, Martin Luther University Halle- Wittenberg and University Hospital Halle, Halle (Saale), Germany
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany.
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Trigo-López J, Guerrero-Peral ÁL, Sierra Á, Martínez-Pías E, Gutiérrez-Sánchez M, Huzzey E, García-Azorín D. Patients and general practitioners assessment of the main outcomes employed in the acute and preventive treatment of migraine: a cross sectional study. BMC Neurol 2021; 21:279. [PMID: 34261459 PMCID: PMC8281698 DOI: 10.1186/s12883-021-02220-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/23/2021] [Indexed: 01/03/2023] Open
Abstract
Background We aim to describe and compare patients and general practitioners’ opinions about the different variables related to acute and preventive treatment for migraine. Patients and methods An observational descriptive study was performed. Patients with episodic migraine and general practitioners, from our healthcare area, were invited to answer a survey about the different variables related to migraine treatment. They were asked for their opinions on the different variables, and to consider the desired efficacy in percentage terms and the desired action times of treatment. Results Fifty-five patients and fifty-five general practitioners were selected. Effectiveness was considered the most important variable for symptomatic and preventive treatment. Cost was considered the least important variable. Patients desired percentage of efficacy was 84.0% (±16.7%) for symptomatic treatment and 79.9% (±17.1%) for preventive treatment. General practitioners desired percentage of efficacy was 75.0% (±14.0) for symptomatic treatment and 70.4% (±14.3) for preventive treatment. For symptomatic treatment the desired action time for pain cessation was selected as 27.5 min (±13.8) for patients and 24.0 min (±18.3) for GPs. For preventive treatment the desired action time for effect was 7.1 days (±4.5) for patients and 13.9 days (±8.9) for general practitioners. Conclusion The most important endpoints were, for acute: effectiveness, a short action time and a persistent effect. For prophylactic: effectiveness, sustained effect and tolerability. Both patients and general practitioners agreed on the most and least preferred endpoints. Desired percentage of efficacy was above 75% for both symptomatic and preventive treatment; and the desired action time was below 30 min for acute treatment and 2 weeks for preventive treatment.
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Affiliation(s)
- Javier Trigo-López
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal 3, 47005, Valladolid, Spain
| | - Ángel Luis Guerrero-Peral
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal 3, 47005, Valladolid, Spain. .,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain. .,Department of Medicine, University of Valladolid, Valladolid, Spain.
| | - Álvaro Sierra
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal 3, 47005, Valladolid, Spain
| | - Enrique Martínez-Pías
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal 3, 47005, Valladolid, Spain
| | - María Gutiérrez-Sánchez
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal 3, 47005, Valladolid, Spain
| | | | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal 3, 47005, Valladolid, Spain
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Chowdhury D, Chandra PS. Headache Disorders: The Painful Truth About the Neglect and Deprivation. Neurol India 2021; 69:S1-S3. [PMID: 34003142 DOI: 10.4103/0028-3886.316000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Thiele A, Strauß S, Angermaier A, Klehr L, Bartsch L, Kronenbuerger M, Schmidt S, Fleischmann R. Treatment Realities of Headache Disorders in Rural Germany by the Example of the Region of Western Pomerania. Brain Sci 2021; 11:839. [PMID: 34202861 PMCID: PMC8301947 DOI: 10.3390/brainsci11070839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/19/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Headache disorders are among the most disabling medical conditions but the supply with experienced providers is outpaced by the demand for service. It is unclear to what extent particularly patients in rural regions are affected by limited access to comprehensive care. Furthermore, it is unknown what role general practitioners (GPs) play in headache care. (2) Methods: First-time consultations to a specialised headache clinic at a tertiary care centre were asked to participate. Their socio-demographic background, general and headache-specific medical history, disability and quality of life (QoL) were assessed. Additionally, 176 GPs in neighbouring districts were contacted regarding headache management. (3) Results: We assessed 162 patients with first-time consultations (age 46.1 ± 17.0 years, 78.1% female), who suffered from migraine (72%), tension type, cluster and secondary headaches (each 5-10%). About 50% of patients received a new headache-diagnosis and 60% had treatment inconsistent with national guidelines. QoL was significantly worse in all domains compared to the general population. About 75% of GPs see headache patients at least several times per week, and mostly treat them by themself. (4) Conclusions: More than every second headache patient was neither correctly diagnosed nor received guideline adherent treatment. Headache-related disability is inferior to what is expected from previous studies. Access to specialised health care is more limited in rural than in urban regions in Germany and GPs request more training.
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Affiliation(s)
- Anne Thiele
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Sebastian Strauß
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Anselm Angermaier
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Lara Klehr
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Luise Bartsch
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Martin Kronenbuerger
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
- Medical School OWL, University of Bielefeld, 33615 Bielefeld, Germany
| | - Sein Schmidt
- Clinical Research Unit, Charité Campus Mitte, Berlin Institute of Health, 10117 Berlin, Germany;
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
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Need of guidance in disabling and chronic migraine identification in the primary care setting, results from the european MyLife anamnesis survey. BMC FAMILY PRACTICE 2021; 22:54. [PMID: 33743604 PMCID: PMC7980340 DOI: 10.1186/s12875-021-01402-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/23/2021] [Indexed: 12/20/2022]
Abstract
Background 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. Methods 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. Results 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. Conclusions 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. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01402-2.
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Ryvlin P, Skorobogatykh K, Negro A, Sanchez-De La Rosa R, Israel-Willner H, Sundal C, MacGregor EA, Guerrero AL. Current clinical practice in disabling and chronic migraine in the primary care setting: results from the European My-LIFE anamnesis survey. BMC Neurol 2021; 21:1. [PMID: 33390161 PMCID: PMC7780632 DOI: 10.1186/s12883-020-02014-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/25/2020] [Indexed: 01/19/2023] Open
Abstract
Background 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. Methods 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. Results 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. Conclusions 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. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-020-02014-6.
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Affiliation(s)
- Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.
| | | | - Andrea Negro
- Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | | | | | - Christina Sundal
- Department of Neurology, Neuroclinic Norway, Lillestrøm, Norway.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Anne MacGregor
- Barts Health NHS Trust, London, UK.,Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Queen Mary University of London, London, UK
| | - Angel L Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain.,Department of Medicine, University of Valladolid, Valladolid, Spain.,Institute for biomedical research of Salamanca (IBSAL), Salamanca, Spain
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13
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Parikh SK, Kempner J, Young WB. Stigma and Migraine: Developing Effective Interventions. Curr Pain Headache Rep 2021; 25:75. [PMID: 34873646 PMCID: PMC8647964 DOI: 10.1007/s11916-021-00982-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW Migraine and other primary headache disorders do not receive adequate research funding, medical resources, or other forms of structural support relative to their prevalence and the disability they cause. In recent research, scholars have argued that stigma associated with headache disorders explains some of this discrepancy. This review will discuss (1) the factors contributing to stigma toward migraine and other primary headache disorders, (2) how structural and enacted stigma may perpetuate individual disability, (3) the impact of internalized stigma, and (4) interventions to mitigate stigma toward headache disorders with an emphasis on outcome monitoring. The review will also propose new areas of stigma research in need of further investigation. RECENT FINDINGS Recent research shows that discrimination can exacerbate chronic pain. Stigma profoundly affects everything from the allocation of federal research funds and healthcare resources to individual patients' self-efficacy and ability to care for themselves. Understanding the stigma of migraine and learning how to develop effective interventions to mitigate this stigma will increase access to appropriate migraine care, improve healthcare providers' ability to care for their migraine patients, and help advocates reverse policies that discriminate against those with migraine. It is important to closely monitor outcomes of anti-stigma efforts for both positive and negative consequences and take note of outcomes and "lessons learned" from anti-stigma campaigns for other diseases.
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Affiliation(s)
- Simy K. Parikh
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Joanna Kempner
- Department of Sociology, Institute of Health, Health Care Policy, and Aging Research, Rutgers University, The State University of New Jersey, New Brunswick, NJ 08901 USA
| | - William B. Young
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107 USA
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14
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Advocacy in Headache Medicine: Tips at the Bedside, the Institutional Level, and Beyond. Curr Neurol Neurosci Rep 2020; 20:52. [DOI: 10.1007/s11910-020-01073-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Indexed: 12/30/2022]
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15
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Dodick DW, Ashina M, Sakai F, Grisold W, Miyake H, Henscheid-Lorenz D, Craven A, Ruiz de la Torre E, Koh R, Reznik N, Bance L, Leroux E, Edvinsson L. Vancouver Declaration II on Global Headache Patient Advocacy 2019. Cephalalgia 2020; 40:1017-1025. [PMID: 32345038 DOI: 10.1177/0333102420921162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2017, the International Headache Society convened a Global Patient Advocacy Summit (GPAS-1) to begin a collaborative effort involving patients, patient advocates, patient advocacy organizations, healthcare professionals, scientists, professional pain, neurology, and headache societies, pharmaceutical manufacturers, and regulatory agencies to advance issues of importance to patients affected by headache worldwide. In September 2019, the second Global Patient Advocacy Summit (GPAS-2) was convened to revisit issues from the inaugural meeting, assess the progress of the International Headache Society Global Patient Advocacy Coalition (IHS-GPAC) in meeting the goals set forth therein, and discuss strategies for achieving established goals and supporting future development. Short- and long-term mandates from the first Summit were realized, including publishing the Vancouver Declaration on Global Headache Patient Advocacy 2018, determining the governing and operational structures of the IHS-GPAC, and helping to facilitate the first World Federation of Neurology World Brain Day dedicated to migraine. Another short-term mandate, creating a unified advocacy strategy, was fulfilled by the Coalition's decision to focus on encouraging support from employers and implementing employee support programs for people with migraine. To help execute the strategy, the Coalition is developing an employer engagement toolkit that will educate employers and employees about the impact of migraine in the workplace, reduce stigma directed toward employees with migraine, and facilitate the care of employees with migraine to reduce the burden of illness and improve workplace productivity. Coalition members will disseminate the toolkit and encourage the adoption of migraine workplace programs by employers worldwide. The Coalition has established an alliance with two global, multinational employers to expand migraine awareness and support among policy makers and other stakeholders around the world. The IHS-GPAC met many of the goals established at GPAS-1, and it has initiated a global strategy focused on the psychosocial and economic toll of headache disorders, especially migraine, in the workplace. Ongoing and future activities will explore a range of opportunities with employers and across the full spectrum of advocacy goals.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rachel Koh
- INvisible Project, Middletown, Connecticut, USA
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16
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Wijeratne T, Grisold W, Dodick D, Carroll W. World Brain Day 2019: migraine, the painful truth. Lancet Neurol 2019; 18:914. [PMID: 31345666 DOI: 10.1016/s1474-4422(19)30281-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/05/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Tissa Wijeratne
- Department of Neurology, Melbourne Medical School and Western Health, Sunshine Hospital, St Albans, VIC 3021, Australia.
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - David Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - William Carroll
- Department of Neurology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Centre for Neuromuscular and Neurological Disorders, Perron Institute, The University of Western Australia, Perth, WA, Australia
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