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

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.