Neurol Sci (2015) 36 (Suppl 1):S157–S159 DOI 10.1007/s10072-015-2143-z

BRIEF COMMUNICATION

Triptan use among hospital workers affected by migraine G. Viticchi • L. Falsetti • L. Buratti • A. Plutino L. Provinciali • M. Silvestrini • M. Bartolini



Ó Springer-Verlag Italia 2015

Abstract Triptans represent the most specific and effective treatment for migraine attacks. Nevertheless, in clinical practice, they are often underused. Hospital workers, in particular physicians, are expected to be more aware of the correct use of specific drugs, especially for a very common disease such as migraine. Aim of this study was to evaluate whether different hospital workers affected by migraine are able to correctly manage the most suitable therapy for their migraine attacks. During a 1-year period, we submitted hospital employees to a structured interview with a questionnaire to investigate the presence of headache and its characteristics. In particular, in the subpopulation of subjects affected by migraine, we took information regarding their usual treatment for the control of attacks. The type of drug and the category of the working activity were synthesized as two different ordinal variables. Difference in the distribution of the different drug categories was evaluated with Chi squared test. Statistics was performed with SPSS 13.0 for Windows systems. We enrolled 1250 consecutive subjects: 20.3 % of the population (254 patients) was affected by migraine. Triptans use was significantly lower than that of non-steroidal anti-inflammatory drugs. The distribution of the use of the drugs was significantly different (p \ 0.0001) at Chi squared test. Among migraineur physicians, only 10.7 % used triptans. Even in G. Viticchi (&)  L. Buratti  A. Plutino  L. Provinciali  M. Silvestrini  M. Bartolini Neurologic Clinic, Marche Polytechnic University, Via Conca 1, 60020 Ancona, Italy e-mail: [email protected] L. Falsetti Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy

this subgroup, we observed a significant difference (p \ 0.0001) in the distribution of the use of the drugs at Chi squared test. Our findings show a reduced use of triptans among hospital workers. These data reflect the unsatisfactory dissemination of knowledge regarding the correct management of migraine attacks and the advantages of treatment with triptans. An incorrect therapeutic approach to migraine contributes to the risk of the most important complications, such as drugs abuse or illness chronicization. These findings suggest that an insufficient awareness of migraine-related therapeutic options also involves hospital workers, including physicians. Keywords Therapy

Migraine  Hospital workers  Triptans 

Introduction Migraine is one of the most common medical conditions, affecting millions of subjects worldwide; moreover, it remains, for a large part of affected people, a sub-diagnosed illness [1, 2]. In several cases, patients do not receive a correct diagnosis and consequently they do not obtain a specific treatment [1–3]. Triptans represent the most specific and effective treatment for migraine attacks [4]. Nevertheless, in clinical practice the use of these drugs is less widespread than that of other, less specific drugs, such as non-steroidal antiinflammatory drugs (NSAIDs). Several studies showed that among recognized migraineurs few subjects are submitted to specific treatment [5]. In a recent investigation, only from 0.7 to 1.0 % of the analyzed population on migraine subjects used triptans [6], while in other studies the percentage varied between 3.0 and 19 % [7, 8].

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Hospital workers, in particular physicians, are expected to be more aware of the correct use of specific drugs, especially for a very common disease such as migraine. Aim of this study was to verify whether hospital workers affected by migraine are actually able to handle the most suitable treatment for their migraine attacks.

Methods Over a 1-year period, during visits for the verification of the ability to work, we submitted each hospital workers of the University Hospital of Ancona to a structured interview with a specific questionnaire. The enrolled hospital employees were representative of all different working roles (physicians, nurses, technicians, sanitary workers and administrative staff members). The survey included several questions concerning the presence of headache and its characteristics; particularly, among subjects affected by migraine, we took information regarding the treatment for the control of their attacks and the typology of employed drugs. We adopted the ID-migraine test, a validated threequestion test to formulate a migraine diagnosis in primary care settings [9]. Sex, the presence of headache and the diagnosis of migraine were collected in different dichotomous variable. Age was considered as a continuous variable. The type of drug used for the attack and the category of the worker were synthesized as two different ordinal variables. Difference of distribution of the different drug categories was evaluated with Chi squared test. Statistics was performed with SPSS 13.0 for Windows systems.

Results We enrolled 1250 consecutive subjects, with a mean age of 40.9 (±11.63) years. Males represented 36.5 % of the sample; 20.3 % of this population (254 patients) was affected by migraine. 160 (62.9 %) migraine patients did not take any drug, 9 (3.74 %) used paracetamol, 22 (8.5 %) triptans, 42 (16.7 %) NSAIDS, 4 (1.7 %) steroids, while 1 (0.34 %) used ergotamines; the remaining part of this patients took undefined analgesics (16 subjects, 6.29 %). Triptans use was significantly lower than NSAIDs. The distribution of the use of the drugs was significantly different (p \ 0.0001) at Chi squared test. Among migraineur physicians (28 subjects, 8.9 %), the results were particularly unexpected. During acute attacks, 19 (67.9 %) did not use any drug, 1 (3.57 %) took paracetamol, 3 (10.7 %) NSAIDS, 1 (3.57) % unspecified analgesic drugs and 1 (3.57 %) still used ergotamines. Only 3 (10.7) % of them used triptans. Even in this subgroup, we observed a

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significant difference (p \ 0.0001) in the distribution of the use of the drugs at Chi squared test.

Discussion Our findings show a reduced habit in the use of triptans among hospital workers. This observation was common in all the categories considered in this investigation. Our results largely overlap literature data concerning larger populations, reflecting a low rate of utilization and a high percentage of treatment discontinuation [10]. Triptans represent, according to international guidelines [4], the most specific and effective therapy for acute migraine attacks. However, their use remains limited among migraineurs. According to our results, the use of NSAIDs or paracetamol is widely preferred. This incorrect therapeutic approach involves all the inhospital workers categories, including physicians. Our data highlight the unsatisfactory dissemination of knowledge about the correct management of migraine attacks among hospital workers, theoretically more sensitized about health problems and, in particular, about the advantages of using the most specific and effective treatments for a well-known and diffuse illness like migraine. Moreover, according to our data, clinicians seem to be scarcely aware about the possible complications of a wrong treatment for migraine attacks, such as drugs abuse or illness chronicization. Spreading the knowledge of the current guidelines and increasing triptans use must be considered a target for a correct management of migraine, particularly among hospital workers. Conflict of interest The authors certify that there is no actual or potential conflict of interest in relation to this article.

References 1. Viticchi G, Silvestrini M, Falsetti L et al (2011) Time delay from onset to diagnosis of migraine. Headache 51:232–236 2. Viticchi G, Silvestrini M, Falsetti L et al (2011) The role of instrumental examinations in delayed migraine diagnosis. Neurol Sci 32:S143–S144 3. Viticchi G, Bartolini M, Falsetti L et al (2013) Diagnostic delay in migraine with aura. Neurol Sci 34:S141–S142 4. Marmura MJ, Silberstein SD, Schwedt TJ (2015) The acute treatment of migraine in adults: the american headache society evidence assessment of migraine pharmacotherapies. Headache 55:3–20 5. Wu J, Hughes MD, Hudson MF, Wagner PJ (2012) Antimigraine medication use and associated health care costs in employed patients. J Headache Pain 13:121–127 6. Da Cas R, Nigro A, Terrazzino S et al (2014) Triptan use in Italy: insights from administrative databases. Cephalalgia (Epub ahead of print)

Neurol Sci (2015) 36 (Suppl 1):S157–S159 7. Panconesi A, Pavone E, Vacca F, Vaiani M, Banfi R (2008) Triptans in the Italian population: a drug utilization study and a literature review. J Headache Pain 9:71–76 8. MacGregor EA, Brandes J, Eikermann A (2003) Migraine prevalence and treatment patterns: the global migraine and zolmitriptan evaluation survey. Headache 43:19–26

S159 9. Cousins G, Hijazze S, Van de Laar FA, Fahey T (2011) Diagnostic accuracy of the ID Migraine: a systematic review and meta-analysis. Headache 51:1140–1148 10. Panconesi A, Pavone E, Franchini M et al (2010) Triptans: low utilization and high turnover in the general population. Cephalalgia 30:576–581

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Triptan use among hospital workers affected by migraine.

Triptans represent the most specific and effective treatment for migraine attacks. Nevertheless, in clinical practice, they are often underused. Hospi...
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