Vol 54, No 4 (2020)
Research Paper
Published online: 2020-07-17

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Treatment and management of migraine in neurological ambulatory practice in Poland by indicating therapy with monoclonal anti-CGRP antibodies

Izabela Domitrz1, Aurelia Lipa2, Jacek Rożniecki3, Adam Stępień4, Wojciech Kozubski5
Pubmed: 32687594
Neurol Neurochir Pol 2020;54(4):337-343.


Aim of study. To analyse Polish neurologists’ familiarity with the diagnostic criteria for migraine, and how their methods of management of migraine work in daily practice.

Clinical rationale for study. Migraine is a common primary headache disease that causes substantial disability and reduces quality of life. Many migraine patients remain undiagnosed and deprived of treatment. Migraine treatment is problematic, and many patients discontinue preventive treatment, mainly because of a lack of efficacy or adverse effects. Antibodies targeting calcitonin gene-related peptide and its receptor seem to be effective and well-tolerated agents in migraine prevention.

Material and methods. This study was conducted using a computer-assisted web interview conducted with 51 neurologists in Poland, who agreed to participate in the study during a phone call. The questionnaire mainly assessed methods of treatment of migraine patients and diagnostic criteria used in neurological practice.

Results. Only one neurologist listed all of the diagnostic criteria for migraine, and 80% of physicians in their practice used only a part of the migraine diagnostic criteria, usually the migraine without aura criteria. On average, each neurologist had 55 patients under continuous care, seeing roughly 18 patients per month. On average, neurologists estimated that 77% of all patients with migraine had episodic migraine, whereas the rest had the chronic form. Importantly, 40% of patients with chronic migraine received all available preventive treatments without a satisfactory effect. Neurologists could offer monoclonal antibodies that target the CGRP-pathway (i.e. anti-CGRP and anti-CGRP receptor monoclonal antibodies) for the prevention of chronic migraine to about one in three patients with a chronic form of the disease.

Conclusions and clinical implications. Migraine is underdiagnosed and undertreated in Poland. Understanding of the diagnostic criteria for migraine among neurologists is insufficient. Most neurologists in Poland see patients in whom anti-CGRP/R-targeting treatment is indicated.

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  1. Goadsby PJ. Bench to bedside advances in the 21st century for primary headache disorders: migraine treatments for migraine patients. Brain. 2016; 139(Pt 10): 2571–2577.
  2. GBD 2016 Neurology Collaborators, GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018; 17(11): 954–976.
  3. Goadsby PJ, Lipton RB, Ferrari MD. Migraine--current understanding and treatment. N Engl J Med. 2002; 346(4): 257–270.
  4. Tepper SJ, Dahlöf CGH, Dowson A, et al. Prevalence and diagnosis of migraine in patients consulting their physician with a complaint of headache: data from the Landmark Study. Headache. 2004; 44(9): 856–864.
  5. Domitrz I, Lipa A, Rozniecki J, et al. Polish omnibus online survey on migraine conducted in a population of 2000 adults. Migrena news 2019;3(6):98-100, International Headache Congress Dublin 05-08. ; 2019.
  6. Stępień A, Prusiński A, Suwała A. Selected epidemiological data on migraine prevalence in Poland. Ból. 2003; 3(4): 9–12.
  7. Burch R, Rizzoli P, Loder E. The Prevalence and Impact of Migraine and Severe Headache in the United States: Figures and Trends From Government Health Studies. Headache. 2018; 58(4): 496–505.
  8. Natoli JL, Manack A, Dean B, et al. Global prevalence of chronic migraine: a systematic review. Cephalalgia. 2010; 30(5): 599–609.
  9. Buse DC, Manack A, Serrano D, et al. Sociodemographic and comorbidity profiles of chronic migraine and episodic migraine sufferers. J Neurol Neurosurg Psychiatry. 2010; 81(4): 428–432.
  10. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38(1): 1–211.
  11. Chalmer MA, Hansen TF, Lebedeva ER, et al. Proposed new diagnostic criteria for chronic migraine. Cephalalgia. 2020; 40(4): 399–406.
  12. Chądzyński P, Kacprzak A, Domitrz W, et al. Migraine headache facilitators in a population of Polish women and their association with migraine occurrence - preliminary results. Neurol Neurochir Pol. 2019; 53(5): 377–383.
  13. Charles A. The pathophysiology of migraine: implications for clinical management. The Lancet Neurology. 2018; 17(2): 174–182.
  14. Evers S, Afra J, Frese A, et al. European Federation of Neurological Societies, Members of the task force:. EFNS guideline on the drug treatment of migraine - report of an EFNS task force. Eur J Neurol. 2006; 13(6): 560–572.
  15. Stępień A. Kryteria diagnostyczne i leczenie migreny w oparciu o obowiązujące zalecenia międzynarodowe. Med Dypl. 2011; 9(186): 81–87.
  16. Monteith T. Chronic Migraine: Epidemiology, Mechanisms, and Treatment. Chronic Headache. 2018: 37–62.
  17. Weatherall MW. The diagnosis and treatment of chronic migraine. Ther Adv Chronic Dis. 2015; 6(3): 115–123.
  18. Ong JJ, Wei DYT, Goadsby PJ. Recent Advances in Pharmacotherapy for Migraine Prevention: From Pathophysiology to New Drugs. Drugs. 2018; 78(4): 411–437.
  19. Blumenfeld AM, Bloudek LM, Becker WJ, et al. Patterns of use and reasons for discontinuation of prophylactic medications for episodic migraine and chronic migraine: results from the second international burden of migraine study (IBMS-II). Headache. 2013; 53(4): 644–655.
  20. Gültekin M, Balci E, İsmaİLOĞULLARI S, et al. Awareness of Migraine Among Primary Care Physicians in Turkey: A Regional Study. Noro Psikiyatr Ars. 2018; 55(4): 354–357.
  21. Kernick D, Stapley S, Hamilton W. GPs' classification of headache: is primary headache underdiagnosed? Br J Gen Pract. 2008; 58(547): 102–104.
  22. Steiner TJ, Stovner LJ, Vos T, et al. Migraine is first cause of disability in under 50s: will health politicians now take notice? J Headache Pain. 2018; 19(1): 17.
  23. Blumenfeld AM, Varon SF, Wilcox TK, et al. Disability, HRQoL and resource use among chronic and episodic migraineurs: results from the International Burden of Migraine Study (IBMS). Cephalalgia. 2011; 31(3): 301–315.
  24. Silberstein SD, Lee L, Gandhi K, et al. Health care Resource Utilization and Migraine Disability Along the Migraine Continuum Among Patients Treated for Migraine. Headache. 2018; 58(10): 1579–1592.
  25. Wang SJ, Fuh JL, Huang SY, et al. Taiwan MAP Study Group. Diagnosis and development of screening items for migraine in neurological practice in Taiwan. J Formos Med Assoc. 2008; 107(6): 485–494.
  26. Społeczne znaczenie migreny z perspektywy zdrowia publicznego i systemu ochrony zdrowia. Zakład Analiz Ekonomicznych i Systemowych Narodowy Instytut Zdrowia Publicznego – Państwowy Zakład Higieny. 2019: Warszawa.
  27. Katarzyńska A, Domitrz I. Codzienny przewlekły ból głowy – historia, epidemiologia, klinika i przyszłość Neurologia i Neurochirurgia Polska. 2009; 43(2): 155–161.
  28. Sacco S, Bendtsen L, Ashina M, et al. European headache federation guideline on the use of monoclonal antibodies acting on the calcitonin gene related peptide or its receptor for migraine prevention. J Headache Pain. 2019; 20(1): 6.
  29. Silberstein SD, Dodick DW, Bigal ME, et al. Fremanezumab for the Preventive Treatment of Chronic Migraine. N Engl J Med. 2017; 377(22): 2113–2122.
  30. Ferrari MD, Diener HC, Ning X, et al. Fremanezumab versus placebo for migraine prevention in patients with documented failure to up to four migraine preventive medication classes (FOCUS): a randomised, double-blind, placebo-controlled, phase 3b trial. Lancet. 2019; 394(10203): 1030–1040.
  31. Stauffer VL, Dodick DW, Zhang Qi, et al. Evaluation of Galcanezumab for the Prevention of Episodic Migraine: The EVOLVE-1 Randomized Clinical Trial. JAMA Neurol. 2018; 75(9): 1080–1088.
  32. Goadsby PJ, Reuter U, Hallström Y, et al. A Controlled Trial of Erenumab for Episodic Migraine. N Engl J Med. 2017; 377(22): 2123–2132.
  33. Skljarevski V, Matharu M, Millen BA, et al. Efficacy and safety of galcanezumab for the prevention of episodic migraine: Results of the EVOLVE-2 Phase 3 randomized controlled clinical trial. Cephalalgia. 2018; 38(8): 1442–1454.
  34. Detke HC, Goadsby PJ, Wang S, et al. Galcanezumab in chronic migraine: The randomized, double-blind, placebo-controlled REGAIN study. Neurology. 2018; 91(24): e2211–e2221.
  35. Tepper S, Ashina M, Reuter U, et al. Safety and efficacy of erenumab for preventive treatment of chronic migraine: a randomised, double-blind, placebo-controlled phase 2 trial. Lancet Neurol. 2017; 16(6): 425–434.
  36. Ashina M, Saper J, Cady R, et al. Eptinezumab in episodic migraine: A randomized, double-blind, placebo-controlled study (PROMISE-1). Cephalalgia. 2020; 40(3): 241–254.
  37. Lipton RB, Goadsby PJ, Smith J, et al. Efficacy and safety of eptinezumab in patients with chronic migraine: PROMISE-2. Neurology. 2020; 94(13): e1365–e1377.
  38. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/761119s000lbl.pdf (22.02.2020).
  39. Negro A, Martelletti P. Patient selection for migraine preventive treatment with anti-CGRP(r) monoclonal antibodies. Expert Rev Neurother. 2019; 19(8): 769–776.