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Barriers to Satisfactory Migraine Outcomes. What Have We Learned, Where Do We Stand?

Authors

  • Marcelo Bigal MD, PhD,

    1. From the Merck Research Laboratories, Whitehouse Station, NJ (M. Bigal); Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal and R.B. Lipton); Universidade Federal Fluminense – Neurology, Niteroi, Rio de Janeiro, Brazil (A.V. Krymchantowski).
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  • Abouch Valenty Krymchantowski MD, PhD,

    1. From the Merck Research Laboratories, Whitehouse Station, NJ (M. Bigal); Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal and R.B. Lipton); Universidade Federal Fluminense – Neurology, Niteroi, Rio de Janeiro, Brazil (A.V. Krymchantowski).
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  • Richard B. Lipton MD

    1. From the Merck Research Laboratories, Whitehouse Station, NJ (M. Bigal); Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal and R.B. Lipton); Universidade Federal Fluminense – Neurology, Niteroi, Rio de Janeiro, Brazil (A.V. Krymchantowski).
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  • Conflict of Interest: Dr. Bigal is an employee of Merck, Inc.

M. E. Bigal, Global Director for Scientific Affairs, Merck Research Laboratories; 1 Merck Drive, Whitehouse Station, NJ, office WHS-3C26 08889. marcelo_bigal@merck.com.

Abstract

Barriers to optimal migraine care have traditionally been divided into a number of categories: under-recognition and underconsultation by migraine sufferers; underdiagnosis and undertreatment by health care professionals; lack of follow-up and treatment optimization. These “traditional” barriers have been recognized and addressed for at least 15 years. Epidemiologic studies suggest that consultation, diagnosis, and treatment rates for migraine have improved although many migraine sufferers still do not get optimal treatment. Herein, we revisit the problem, review areas of progress, and expand the discussion of barriers to migraine care. We hypothesize that the subjective nature of pain and difficulty in communicating it contributes to clinical and societal barriers to care. We then revisit some of the traditional barriers to care, contrasting rates of recognition, diagnosis, and treatment over the past 15 years. We follow by addressing new barriers to migraine care that have emerged as a function of the knowledge gained in this process.

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