Real-life practice for managing patients with chronic migraine

Introduction. Diagnosis and treatment of chronic migraine (CM) has not been sufficiently investigated in the Russian neurological practice, which formed the basis for conducting this study.

Aim. To evaluate the quality of diagnosis and treatment of CM and comorbid disorders in real-life neurological practice. Materials and methods. The study included 200 patients with CM (63 men and 137 women, mean age 33.1 ± 7,1 years) who sought advice from A.Ya. Kozhevnikov Clinic of Neurologic Diseases (CND) of Sechenov University with complaints of headache (HA). Prior to the study, the patients visited neurologists in other healthcare facilities to receive advice and treatment. Each patient underwent a clinical interview, analysis of previous management, and testing.

Results. Prior to contacting CND only 6% of patients had a diagnosis of CM. All patients had previously undergone additional examinations, mainly neuroimaging of the cervical spine and brain, ultrasound examination of the neck vessels, even if there were no "red flags". Over 90% of patients were diagnosed with drug-induced headache (DIHA) and/or comorbid disorders (increased anxiety, depressive symptoms, insomnia and/or musculoskeletal pain) in the CND settings, and only 8% of patients were diagnosed in other healthcare facilities. All patients had their own experience of treatment with drugs and non-drug methods that are not consistent with the clinical guidelines for the management of migraine. Only 8.5% of patients with DIHA had previously received treatment aimed at resolving that condition. None of those who sought advice from the CND had previously received any cognitive behavioural therapy or treatment using a comprehensive personalized approach with due account for their comorbid disorders.

Conclusion. In real-life neurological practice, CM and comorbid neurological disorders are inadequately diagnosed, additional examinations are assigned in the absence of "red flags" and treatment methods that are not consistent with the clinical guidelines for the management of migraine are used. The comprehensive personalized approach involving effective drug and nondrug methods of treatment taking into account comorbid disorders is not applied.

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