Prevalence Rates of Primary Headache Disorders and Evaluation and Treatment Patterns Among Korean Neurologists

Abstract

Background and purpose: Several studies have found that the prevalence of migraine is higher among healthcare professionals than in the general population. Furthermore, several investigations have suggested that the personal experiences of neurologists with migraine can influence their perception and treatment of the disease. This study assessed these relationships in Korea.

Methods: A survey was used to investigate the following characteristics among neurologists: 1) the prevalence rates of migraine, primary stabbing headache, and cluster headache, and 2) their perceptions of migraine and the pain severity experienced by patients, diagnosing migraine, evaluation and treatment patterns, and satisfaction and difficulties with treatment.

Results: The survey was completed by 442 actively practicing board-certified Korean neurologists. The self-reported lifetime prevalence rates of migraine, migraine with aura, primary stabbing headache, and cluster headache were 49.8%, 12.7%, 26.7%, and 1.4%, respectively. Few of the neurologists used a headache diary or validated scales with their patients, and approximately half were satisfied with the effectiveness of preventive medications. Significant differences were observed between neurologists who had and had not experienced migraine, regarding certain perceptions of migraine, but no differences were found between these groups in the evaluation and preventive treatment of migraine.

Conclusions: The high self-reported lifetime prevalence rates of migraine and other primary headache disorders among Korean neurologists may indicate that these rates are underreported in the general population, although potential population biases must be considered. From the perspective of neurologists, there is an unmet need for the proper application of headache diaries, validated scales, and effective preventive treatments for patients. While the past experiences of neurologists with migraine might not influence how they evaluate or apply preventive treatments to migraine, they may influence certain perceptions of the disease.

Keywords: Korea; disease management; neurologists; prevalence; primary headache disorders; surveys.

Fig. 1. Work characteristics of respondents. A: Results for (i) confidence in diagnosing migraine, and the (ii) routine use of a headache diary, Migraine Disability Assessment (MIDAS) or Headache Impact Test (HIT)-6, and Beck Depression Inventory (BDI) or Patient Health Questionnaire (PHQ)-9: (percentage of respondents who answered ‘use for most patients’ [other possible answers were ‘use it for some patients’ and ‘do not use it’]) according to the work setting. Work settings were compared using one-way analysis of variance for the confidence in diagnosing migraine, and Fisher’s exact two-sided test in each possible two-group comparison for all other analyses. ^*Statistically significant for comparisons of work settings. B: Results for (i) confidence in diagnosing migraine, and the (ii) routine use of a headache diary, MIDAS or HIT-6, and BDI or PHQ-9: (percentage of respondents who answered ‘use for most patients’ [other possible answers were ‘use it for some patients’ and ‘do not use it’]) by neurologists who treat either >100 or ≤100 headache patients per month. The ‘treat >100 headache patients per month’ group was compared with the ‘treat ≤100 headache patients per month’ group using an unpaired t-test to assess the confidence in diagnosing migraine, while a two-way chi-square test was used for all other analyses. ^*Statistically significant for the comparison between the ‘treat >100 headache patients per month’ and ‘treat ≤100 headache patients per month’ groups. C: Percentages of respondent neurologists working in training hospitals, nontraining general hospitals, nursing hospitals, and private clinics are shown, along with percentages of neurologists who treat >100 headache patients per month in the ‘migraine in lifetime’ and ‘no migraine in lifetime’ groups. The ‘migraine in lifetime’ group was compared with the ‘no migraine in lifetime’ group using a two-way chi-square test for all analyses. SE, standard error.