Poor medical care for people with migraine in Europe - evidence from the Eurolight study

Background: Migraine is prevalent everywhere, and disabling. It is also neglected: consequently, it is under-diagnosed and undertreated. We analysed data from the Eurolight study on consultations and utilization of migraine-specific medications as indicators of adequacy of medical care in Europe. Methods: Eurolight was a cross-sectional questionnaire-based survey in 10 European countries. Sampling was population-based in six (Germany, Italy, Lithuania, Luxembourg, Netherlands, Spain) and from consecutive patients attending general practitioners (GPs) for any reason in three (Austria, France, UK). Additional samples in Netherlands and Spain, and the only sample from Ireland, were recruited by lay headache organisations. We recorded migraine prevalence and frequency, and utilization of medical services and medications (acute and preventative). Results: Among 9247 participants (mean age 43.9 +/- 13.9 years, M/F ratio 1: 1.4), 3466 (37.6%) were diagnosed with migraine (definite or probable). Of these, 1175 (33.8%) reported frequent migraine (> 5 days/month) and might clearly expect benefit from, and therefore had need of, preventative medication. In population-based samples, minorities of participants with migraine had seen a GP (9.5-18.0%) or specialist (3.1-15.0%), and smaller minorities received adequate treatment: triptans 3.4-11.0%, with Spain outlying at 22.4%; preventative medication (1.6-6.4% of those eligible, with Spain again outlying at 13.7%). Proportions were greater in GP-based samples (13.6-24.5% using triptans, 4.4-9.1% on preventative medication) and among those from lay organisations (46.2-68.2% and 16.0-41.7%). Participants with migraine who had consulted specialists (3.1-33.8%) were receiving the best care by these indicators; those treated by GPs (9.5-29.6%) fared less well, and those dependent on self-medication (48.0-84.2%) were, apparently, inadequately treated. Conclusion: In wealthy European countries, too few people with migraine consult physicians, with proportionately too many of these seeing specialists, and migraine-specific medications are used inadequately even among those who do. These findings represent yet another call for action in Europe to improve care for people with headache. Education of both health-care providers and the public should be central to this action.