individuals), none of the patients reported receiving preventive treatment.
Adding migraine with probable migraine, considering both as only one disease, 30.1% of the population would be affected, 8.4% of the whole population would need prophylaxis, 16,055,000 people. Table 1 describes the total number of primary headache diagnosis patients, number of patients with MIDAS higher than 10 and number of patients who reported any prevention treatment.
Our study shows a significant undertreatment of primary headaches in Brazil. In average more than 90% of those in need of preventive treatment are not getting appropriate treatment. Migraine showed the highest rates of both prevalence and impact.
Migraine and probable migraine patients in need for prevention, together, accounted for a total of 8.4% of the Brazilian population. It is a major public health issue that should be dealt with. However, no public health policy is current available for the management of migraine disorders in Brazil. Interestingly probable migraine had a higher rate for preventive treatment compared to migraine.
We used MIDAS higher than 10 as a criteria for prevention treatment need. We choose this arbitrary cut point in order to meet not only a minimum of headache frequency but also headaches with a certain impact. Considering MIDAS refers to 3 months, eleven points would translate into three headache days with at least 50% of disability. Most of the migraine prophylaxis consensus worldwide suggest start a medication or intervention with 2 or 3 attacks per month. We think the measure chosen here is better than just headache frequency.
Migraine undertreatment is also present in other countries. The AMPP study7 showed that 25.7% of migraineurs needed prevention, compared to 24.7% found in our study. Only 13.0% of sufferers in the US were taking daily preventive medication, but in our sample, a lot less (2.6%) patients were on prophylaxis.
The national French migraine study (FRAMIG 2000)8 found that only 6% of migraine sufferers actually took a true prophylactic treatment, and another 4% mistakenly considered the analgesics they took daily as prophylactic treatments.
Improve the rate of migraine prevention is one of the most important challenges in neurological practice, public health initiatives should be focus this issue.
Headache Medicine, v.2, n.2, p.46-49, Apr./May/Jun. 2011
Migraine and tension-type headache are common, severe, debilitating neurological conditions but a substantial proportion of those who might need prevention do not receive it.
Patient education, public health initiatives in order to deliver migraine and other primary headaches treatment for the general population, as well as continuing medical education in all levels (medical school, residency, internal medicine, family medicine, ginecology, pediatrics, neurology) should be considered not only in Brazil, but worldwide.
1.Pfaffenrath V, Fendrich K, Vennemann M, Meisinger C, Ladwig KH, Evers S, et al. Regional variations in the prevalence of migraine and tension-type headache applying the new IHS criteria: the German DMKG Headache Study. Cephalalgia. 2009;29(1):48-57.
2.Queiroz LP, Peres MF, Piovesan EJ, Kowacs F, Ciciarelli MC, Souza JA, et al. A nationwide population-based study of migraine in Brazil. Cephalalgia. 2009;29(6):642-9.
3.Queiroz LP, Peres MF, Piovesan EJ, Kowacs F, Ciciarelli MC, Souza JA, et al. A nationwide population-based study of tensiontype headache in Brazil. Headache. 2009;49(1):71-8.
4.Queiroz LP, Peres MF, Kowacs F, Piovesan EJ, Ciciarelli MC, Souza JA, et al. Chronic daily headache in Brazil: a nationwide population-based study. Cephalalgia. 2008; 28(12):1264-9.
5.Lipton RB, Bigal ME, Kolodner K, Stewart WF, Liberman JN, Steiner TJ. The family impact of migraine: population-based studies in the USA and UK. Cephalalgia. 2003;23(6):429-40.
6.Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF; AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68(5): 343-9.
7.Diamond S, Bigal ME, Silberstein S, Loder E, Reed M, Lipton RB. Patterns of diagnosis and acute and preventive treatment for migraine in the United States: results from the American Migraine Prevalence and Prevention study. Headache. 2007;47(3):35563. Erratum in: Headache. 2007;47(9):1365.
8.Lucas C, Chaffaut C, Artaz MA, Lantéri-Minet M. FRAMIG 2000: medical and therapeutic management of migraine in France. Cephalalgia. 2005;25(4):267-79.
Dr. Mario F. P. Peres
R. Joaquim Eugenio de Lima, 881 cj 708
Sao Paulo Brazil