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. 2021 Sep 9;22(1):106.
doi: 10.1186/s10194-021-01316-5.

Migraine patients in Germany - need for medical recognition and new preventive treatments: results from the PANORAMA survey

M Koch  1 , Z Katsarava  2   3   4   5 , C Baufeld  1 , K Schuh  1 , A Gendolla  6 , A Straube  7 , W von Pannwitz  8 , W E Hofmann  9 , S Ortler  10
Affiliations

Migraine patients in Germany - need for medical recognition and new preventive treatments: results from the PANORAMA survey

M Koch et al. J Headache Pain. .

Abstract

Background: Migraine is a primary headache disorder characterized by recurrent attacks that may have a significant impact on patients' daily life. Treatment options must often be re-evaluated in light of efficacy, tolerability and compliance issues. Few data on commonly applied treatment algorithms and treatment failures have existed in Germany in 2017/2018. The PANORAMA survey was designed to explore and characterize the migraine healthcare landscape and to demonstrate the medical treatment need at that time in Germany.

Methods: Three different questionnaires were used to assess the profile of the 119 participating centers, characterize migraine patients at centers and evaluate qualitative aspects of the current migraine healthcare situation from a physician´s professional perspective. Data were analyzed as observed and summarized by descriptive statistics.

Results: The results demonstrate that once referred to a migraine specialist, the majority of patients continue to be treated at a specialist. At specialized centers, 41.6 % of migraine patients receive prophylactic treatment. 45.4 % of prophylactic treatments are initiated with a beta-blocker and 28.1 % with an anti-epileptic. Pivotal factors to initiate prophylactic treatment are migraine attack frequency and intensity (58.0 %). Treatment decisions are largely based on prior / concomitant diseases and physical constitution of the patient (52.1 %). Following an inadequate treatment, most patients either switch substance class or discontinue prophylactic treatment.

Conclusions: PANORAMA gives a comprehensive overview of the migraine healthcare landscape in Germany in 2017/2018, elucidates a lack of common treatment algorithms and reveals a high demand for defined therapy strategies and new prophylactic treatment going forwards.

Keywords: Headache; Healthcare systems; Migraine; Patient care; Preventive treatment.

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Conflict of interest statement

MK, CB, KS and SO are employees of Novartis Pharma GmbH. ZK received honoraria from Allergan GmbH, Merck KGaA, TEVA GmbH, Lilly GmbH, Novartis Pharma GmbH and Daiichi Sankyo GmbH. AG received honoraria from Allergan GmbH, Reckitt Benckiser GmbH, St. Jude Medical Inc., Bayer AG, Grünenthal GmbH, Mundipharma GmbH, Zahnärztekammer KVNO (Kassenärztliche Vereinigung Nordrhein), GAF, Novartis Pharma GmbH, Lilly GmbH, TEVA GmbH, Hormosan Pharma GmbH and Allergan/Abbvie GmbH & Co. KG. AS received honoraria for consulting and lectures within the past three years from Allergan GmbH, Bayer AG, Lilly GmbH, Novartis Pharma GmbH, Sanofi-Aventis GmbH and TEVA GmbH. WvP received honoraria for consulting, lectures and study activities from Bayer Vital GmbH, Biogen GmbH, Merck Serono GmbH, Novartis Pharma GmbH, Roche Pharma AG, TEVA GmbH, Sanofi-Aventis GmbH, STADA Pharm GmbH and UCB Pharma GmbH. WEH received honoraria for consulting from Desitin Arzneimittel GmbH, Bayer AG, TEVA GmbH and Novartis Pharma GmbH, and for lectures from TEVA GmbH and Novartis Pharma GmbH.

Figures

Fig. 1
Fig. 1
Schematic overview of the referral structure of medical care for migraine patients
Fig. 2
Fig. 2
Referral of patients to headache specialists by type of physician or health care professional
Fig. 3
Fig. 3
Proportion of patients at distinct stages of prophylaxis at specialized centers in 2017/2018 (n = number of questionnaires included in the evaluation)
Fig. 4
Fig. 4
[A] Reasons for prophylactic migraine treatment initiation (multiple answers allowed); [B] Reasons for prophylactic migraine treatment choice (multiple answers allowed) in 2017/2018
Fig. 5
Fig. 5
Treatment sequence of prophylactic migraine substance classes (predefined answers, n = number of questionnaires included in the evaluation)
Fig. 6
Fig. 6
Therapeutic options after discontinuation of prophylactic migraine treatment
See this image and copyright information in PMC

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