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Table 3 Studies reporting clinical management of migraine

From: Prevalence, burden, and clinical management of migraine in China, Japan, and South Korea: a comprehensive review of the literature

CitationCountry/regionStudy design
Study dates
Migraine criteriaPopulation (n)Main findings for participants with migraine
Wang, 2011 and Li, 2012 [22, 28]China / MainlandCross-sectional other: neurological outpatient department
2010
ICHD-II401 patients with migrainePractice pattern over the past 1 y:
• 68.6% of patients had consulted a physician, 13.5% were diagnosed with migraine, 37.2% had not received any diagnosis
Treatment over the past 3 mo:
• 43.1% had not used analgesics for migraine, 11.7% were using analgesics ≥3 days/wk., none had used triptans, 2.7% had used preventive drugs
Liu, 2013 [24]China / MainlandPopulation-based
2009
ICHD-II452 adults with migrainePractice pattern over the past 1 y:
• 52.9% of adults had consulted a physician for headache
• 52.7% of adults who had a consultation for headache were undiagnosed
• 13.8% were diagnosed with migraine, the remaining were diagnosed with other headache disorders
Significant predictors of consultation for migraine were mild, moderate, or severe disability (HALT index) vs minimal HALT (0–5 days lost/3 mo):
• Mild 6–10 days lost: adjusted OR 3.4 (95% CI, 1.6–7.4)
• Moderate 11–20 days lost: adjusted OR 2.5 (95% CI, 1.2–5.4)
• Severe > 20 days lost: adjusted OR 3.9 (95% CI, 1.9–8.1)
Lu, 2001 [35]China / TaiwanPopulation-based
1997–1998
> 15 headache days/mo for > 1 mo; > 4-h duration108 adults with chronic daily headachePractice pattern and treatment over the past 1 y:
• 57% had consulted a physician for their headache
• 41% consulted their family physician, 28% neurologist
• 5% were treated with preventive drugs
Wang, 2000; Wang, 2001 [43, 44]China / TaiwanPopulation-based
1997–1998
IHS migraine and modified migraine (IHS + attacks of 2- to 4-h duration)328 adults with migrainePractice pattern over the past 1 y:
• 54% had consulted a physician for the headache
• 18% of these had been diagnosed with migraine by their physician
Treating physicians
• 29% general practitioners
• 17% internists, 14% ENT specialists, 12% neurologists
• 4.9% gynecologists, 4.6% ophthalmologists, 1.2% allergists, 2.7% other
Lu, 2006 [37]China / TaiwanCross-sectional other: neurologists in Taiwan
NR
NA123 neurologists in Taiwan31.7% of patients seen were outpatients with migraine
Attitudes:
• 88.5% reported headache to be an important part of their practice
• 40.2% thought headache patients to be time-consuming
• 86.9% reported patient satisfaction as an important consideration for treatment
• 89.9% thought behavioral therapy to be an important part of treatment
Treatment:
• 69.9% agreed that preventive medication was indicated for ≥2 migraine attacks/wk., but 12.2% prescribed preventives for patients with ≥14 headaches/mo
• Most commonly prescribed drugs were beta-blockers (96.7%), flunarizine (87.0%), tricyclic antidepressants (80.5%), and valproic acid (54.5%)
• 32.5% had never prescribed triptans, mostly because of cost (35%)
Wang, 2008 [39]China / TaiwanCross-sectional other: neurological clinics
2005
ICHD-II (MOA, MWA, probable)755 patients with headache attending a neurology clinic for the first time60% were diagnosed by neurologists with migraine
48% had MWA or MOA (ICHD-II)
71% had any migraine type (ICHD-II) of these, 23% were not diagnosed by neurologists as having migraine
57.4% diagnosed with any migraine (ICHD-II) had never been diagnosed with migraine previously
Wang, 2013 [46]China / TaiwanCross-sectional other: headache clinics
2011
Neurologist diagnosis / ICHD-II331 adults with migraine at neurology clinicsOver the past 3 mo for chronic migraine vs episodic migraine
Health care professional evaluation of headache: 85.6% vs 81.7%
• General practitioner: 34.3% vs 24.6%
• Neurologist/specialist: 79.0% vs 80.6%
• Emergency room visits: 21.0% vs 5.5%
• Hospital admission: 4.8% vs 0%
• Preventive medication: 48.5% vs 31.7%
Sakai, 1997 [51]JapanPopulation-based
NR
IHS migraine and modified migraine (IHS + attacks of 2- to 4-h duration)338 adults with IHS-defined or other defined migraine69.4% had never consulted a physician for headache
11.6% were aware their headache was migraine
56.8% were taking OTC drugs
5.4% were taking prescription drugs
18.6% were taking OTC and prescription drugs
19.2% were not taking any medication
Takeshima, 2004 [53]JapanPopulation-based
1999
IHSAdults
41 with MWA 301 with MOA
MWA vs MOA
Most never consulted a physician for migraine 61.0% vs 71.8%
Few continuously consulted a physician for migraine 7.3% vs 5.3%
Main reasons for not consulting or not continuing to consult a physician:
• Headache not severe enough 35.7% vs 29.3%; 38.5% vs 30.4%
• Will improve spontaneously after standing 57.1% vs 56.9%; 30.8% vs 27.5%
• OTC medication effective 21.4% vs 53.7%; 23.1% vs 30.4%
Kotani, 2004 [50]JapanCross-sectional: other
NR
IHS35 patients with migraine at a general health clinicMain reasons for not previously seeking medical attention:
• 28.6% can endure symptoms without medication
• 28.6% OTC medication is effective
• 28.6% could not miss work
• 25.7% could sleep and wake pain-free
Suzuki, 2014 [52]JapanCommunity-based
2007–2008
ICHD-II704 employees in Tokyo1.3% regularly visited their physicians
59.4% had never consulted with a physician about their headaches
The most common reasons (n = 173) for stopping visits to a physician were: told their condition was not fatal (45.1%), unable to get adequate advice from their physician (20.2%), and no time (14.5%)
Roh, 1998 [59]South KoreaPopulation-based
1996
IHS272 adults with migraine64.3% used medication for their migraine
92.8% used OTC medication
24.4% had consulted a physician for headache
Children/adolescents
Lu, 2000 [36]China/ TaiwanPopulation-based
1998–1999
IHSChildren
13–15 y, 277
72.1% of children used painkillers for their headache
11.5% used painkillers ≥1 d/wk
Goto, 2017 [48]JapanPopulation-based
2012
ICHD-IIIβ (unilateral aura not included)Children
6–12 y, 48
12–15 y, 37
Elementary school and junior high school students who reported disability due to migraine:
• 44.9% and 47.9% had not had a medical consultation for their migraine
• 30.6% and 8.3% had not received prescription medication for their migraine
  1. CI confidence interval; F female; HALT Headache-Attributed Lost Time Index; ICHD-I/II/IIIβ International Classification of Headache Disorders; ICD-9-CM International Classification of Diseases, 9th revision, Clinical Modification; IHS International Headache Society; NA not applicable; NR not reported; MOA migraine without aura; MWA migraine with aura; OTC over-the-counter; OR odds ratio; SD standard deviation
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