Migraine Disability Awareness Campaign in Asia: Migraine Assessment for Prophylaxis

Authors

  • Shuu-Jiun Wang MD,

    1. From the Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-J. Wang); Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea (C.-S. Chung); Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (S. Chankrachang); The Headache and Migraine Clinic, Jaslok and Lilavati Hospitals, Mumbai, India (K. Ravishankar); Pantai Medical Centre, Kuala Lumpur, Malaysia (J. S. Merican); Lucena Doctors’ Hospital, Lucena City, Philippines (G. Salazar); National Neuroscience Institute, Department of Neurology, Singapore (C. Siow); Department of Medicine, University of Hong Kong, Hong Kong (R. T.-F. Cheung); Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K. Phanthumchinda); Department of Neurology, Kitasato University, Japan (F. Sakai).
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  • Chin-Sang Chung MD, PhD,

    1. From the Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-J. Wang); Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea (C.-S. Chung); Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (S. Chankrachang); The Headache and Migraine Clinic, Jaslok and Lilavati Hospitals, Mumbai, India (K. Ravishankar); Pantai Medical Centre, Kuala Lumpur, Malaysia (J. S. Merican); Lucena Doctors’ Hospital, Lucena City, Philippines (G. Salazar); National Neuroscience Institute, Department of Neurology, Singapore (C. Siow); Department of Medicine, University of Hong Kong, Hong Kong (R. T.-F. Cheung); Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K. Phanthumchinda); Department of Neurology, Kitasato University, Japan (F. Sakai).
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  • Siwaporn Chankrachang MD,

    1. From the Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-J. Wang); Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea (C.-S. Chung); Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (S. Chankrachang); The Headache and Migraine Clinic, Jaslok and Lilavati Hospitals, Mumbai, India (K. Ravishankar); Pantai Medical Centre, Kuala Lumpur, Malaysia (J. S. Merican); Lucena Doctors’ Hospital, Lucena City, Philippines (G. Salazar); National Neuroscience Institute, Department of Neurology, Singapore (C. Siow); Department of Medicine, University of Hong Kong, Hong Kong (R. T.-F. Cheung); Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K. Phanthumchinda); Department of Neurology, Kitasato University, Japan (F. Sakai).
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  • K. Ravishankar MD,

    1. From the Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-J. Wang); Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea (C.-S. Chung); Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (S. Chankrachang); The Headache and Migraine Clinic, Jaslok and Lilavati Hospitals, Mumbai, India (K. Ravishankar); Pantai Medical Centre, Kuala Lumpur, Malaysia (J. S. Merican); Lucena Doctors’ Hospital, Lucena City, Philippines (G. Salazar); National Neuroscience Institute, Department of Neurology, Singapore (C. Siow); Department of Medicine, University of Hong Kong, Hong Kong (R. T.-F. Cheung); Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K. Phanthumchinda); Department of Neurology, Kitasato University, Japan (F. Sakai).
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  • Julia Shahnaz Merican MBBch, LRCPSI, MRCP,

    1. From the Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-J. Wang); Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea (C.-S. Chung); Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (S. Chankrachang); The Headache and Migraine Clinic, Jaslok and Lilavati Hospitals, Mumbai, India (K. Ravishankar); Pantai Medical Centre, Kuala Lumpur, Malaysia (J. S. Merican); Lucena Doctors’ Hospital, Lucena City, Philippines (G. Salazar); National Neuroscience Institute, Department of Neurology, Singapore (C. Siow); Department of Medicine, University of Hong Kong, Hong Kong (R. T.-F. Cheung); Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K. Phanthumchinda); Department of Neurology, Kitasato University, Japan (F. Sakai).
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  • Gerard Salazar MD,

    1. From the Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-J. Wang); Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea (C.-S. Chung); Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (S. Chankrachang); The Headache and Migraine Clinic, Jaslok and Lilavati Hospitals, Mumbai, India (K. Ravishankar); Pantai Medical Centre, Kuala Lumpur, Malaysia (J. S. Merican); Lucena Doctors’ Hospital, Lucena City, Philippines (G. Salazar); National Neuroscience Institute, Department of Neurology, Singapore (C. Siow); Department of Medicine, University of Hong Kong, Hong Kong (R. T.-F. Cheung); Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K. Phanthumchinda); Department of Neurology, Kitasato University, Japan (F. Sakai).
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  • Charles Siow MB, BCh, BAO, ABPN, ABPM,

    1. From the Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-J. Wang); Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea (C.-S. Chung); Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (S. Chankrachang); The Headache and Migraine Clinic, Jaslok and Lilavati Hospitals, Mumbai, India (K. Ravishankar); Pantai Medical Centre, Kuala Lumpur, Malaysia (J. S. Merican); Lucena Doctors’ Hospital, Lucena City, Philippines (G. Salazar); National Neuroscience Institute, Department of Neurology, Singapore (C. Siow); Department of Medicine, University of Hong Kong, Hong Kong (R. T.-F. Cheung); Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K. Phanthumchinda); Department of Neurology, Kitasato University, Japan (F. Sakai).
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  • Raymond Tak-Fai Cheung MD, PhD,

    1. From the Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-J. Wang); Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea (C.-S. Chung); Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (S. Chankrachang); The Headache and Migraine Clinic, Jaslok and Lilavati Hospitals, Mumbai, India (K. Ravishankar); Pantai Medical Centre, Kuala Lumpur, Malaysia (J. S. Merican); Lucena Doctors’ Hospital, Lucena City, Philippines (G. Salazar); National Neuroscience Institute, Department of Neurology, Singapore (C. Siow); Department of Medicine, University of Hong Kong, Hong Kong (R. T.-F. Cheung); Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K. Phanthumchinda); Department of Neurology, Kitasato University, Japan (F. Sakai).
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  • Kammant Phanthumchinda MD,

    1. From the Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-J. Wang); Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea (C.-S. Chung); Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (S. Chankrachang); The Headache and Migraine Clinic, Jaslok and Lilavati Hospitals, Mumbai, India (K. Ravishankar); Pantai Medical Centre, Kuala Lumpur, Malaysia (J. S. Merican); Lucena Doctors’ Hospital, Lucena City, Philippines (G. Salazar); National Neuroscience Institute, Department of Neurology, Singapore (C. Siow); Department of Medicine, University of Hong Kong, Hong Kong (R. T.-F. Cheung); Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K. Phanthumchinda); Department of Neurology, Kitasato University, Japan (F. Sakai).
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  • Fumihiko Sakai MD

    1. From the Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-J. Wang); Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea (C.-S. Chung); Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (S. Chankrachang); The Headache and Migraine Clinic, Jaslok and Lilavati Hospitals, Mumbai, India (K. Ravishankar); Pantai Medical Centre, Kuala Lumpur, Malaysia (J. S. Merican); Lucena Doctors’ Hospital, Lucena City, Philippines (G. Salazar); National Neuroscience Institute, Department of Neurology, Singapore (C. Siow); Department of Medicine, University of Hong Kong, Hong Kong (R. T.-F. Cheung); Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K. Phanthumchinda); Department of Neurology, Kitasato University, Japan (F. Sakai).
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  • Conflict of Interest: None

S.-J. Wang, The Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan.

Abstract

Objectives.— This study aimed to survey the headache diagnoses and consequences among outpatients attending neurological services in 8 Asian countries.

Methods.— This survey recruited patients who consulted neurologists for the first time with the chief complaint of headache. Patients suffering from headaches for 15 or more days per month were excluded. Patients answered a self-administered questionnaire, and their physicians independently completed a separate questionnaire. In this study, the migraine diagnosis given by the neurologists was used for analysis. The headache symptoms collected in the physician questionnaire were based on the diagnostic criteria of migraine proposed by the International Classification of Headache Disorders, second edition (ICHD-2).

Results.— A total of 2782 patients (72% females; mean age 38.1 ± 15.1 years) finished the study. Of them, 66.6% of patients were diagnosed by the neurologists to have migraine, ranging from 50.9% to 85.8% across different countries. Taken as a group, 41.4% of those patients diagnosed with migraine had not been previously diagnosed to have migraine prior to this consultation. On average, patients with migraine had 4.9 severe headaches per month with 65% of patients missing school, work, or household chores. Most (87.5%) patients with migraine took medications for acute treatment. Thirty-six percent of the patients had at least one emergency room consultation within one year. Only 29.2% were on prophylactic medications. Neurologists recommended pharmacological prophylaxis in 68.2% of patients not on preventive treatment. In comparison, migraine prevalence was the highest with ICHD-2 “any migraine” (ie, migraine with or without migraine and probable migraine) (73.3%) followed by neurologist-diagnosed migraine (66.6%) and ICHD-2 “strict migraine” (ie, migraine with or without aura only) (51.3%). About 88.6% patients with neurologist-diagnosed migraine fulfilled ICHD-2 any migraine but only 67.1% fulfilled the criteria of ICHD-2 strict migraine.

Conclusions.— Migraine is the most common headache diagnosis in neurological services in Asia. The prevalence of migraine was higher in countries with higher referral rates of patients to neurological services. Migraine remains under-diagnosed and under-treated in this region even though a high disability was found in patients with migraine. Probable migraine was adopted into the migraine diagnostic spectrum by neurologists in this study.

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