Migraine treatment: quo vadis? Real-world data study (2015-2022) in Spain.

BACKGROUND: Migraine is a leading cause of disability, estimated to affect one-in-ten people in Spain. This study aimed to describe the management of migraine in Spain and identify improvement areas. METHODS: Non-interventional, retrospective, cross-sectional cohort study conducted using an electronic medical records database covering visits to public healthcare providers for 3% of the Spanish population. Patients with a migraine diagnosis (ICD-9 346) between 01/2015 and 04/2022 were included, as well as their demographic and clinical characteristics, prescribed migraine treatments and the specialty of the prescribing physicians. RESULTS: The database included 61,204 patients diagnosed with migraine. A migraine treatment had been prescribed to 50.6% of patients over the last 24 months (only acute to 69.5%, both acute and preventive to 24.2%, and only preventive to 6.3%). The most frequently prescribed treatments were NSAIDs (56.3%), triptans (44.1%) and analgesics (28.9%). Antidepressants were the most common preventive treatment (prescribed to 17.9% of all treated patients and 58.7% of those treated with a preventive medication), and anti-CGRP monoclonal antibodies the least prescribed (1.7%; 5.7%). In 13.4% of cases, preventive medications were the first treatment: alone in 5.8% of cases and together with an acute medication in 7.6%. A fifth of patients who were initially prescribed with only acute treatment were later prescribed a preventive medication (20.7%). On average, it took 29.4 months for this change to occur. Two-thirds of patients started their preventive treatment in primary care (64.2%). The percentage of patients treated by a neurologist increased with the number of received preventive medications. However, 28.8% of patients who had already been prescribed five or more distinct preventive treatments were not treated by a neurologist. Migraine patients had between 1.2- and 2.2-times higher prevalence of comorbidities than the general population, age-gender adjusted. CONCLUSIONS: Our study emphasizes the need for improved management of migraine in Spain to reduce the risk of chronification and improve patient outcomes. More training and coordination across healthcare professionals is necessary to recognize and address risk factors for migraine progression, including multiple associated comorbidities and several lines of treatment, and to provide personalized treatment plans that address the complex nature of the condition.

Crafting urban equality through grassroots critical pedagogies: weave, sentipensar, mobilize, reverberate, emancipate.

How do ordinary citizens, activists and urban practitioners learn to become agents of change for a socially just habitat? The paper explores this question through the experiences of eight grassroots schools of popular urbanism working under the umbrella of the Habitat International Coalition (HIC) in Latin America. Building on a process of self-documentation and collective pedagogic reflection driven by the protagonists of these schools, the analysis explores the core pedagogic practices identified across the schools to enact popular urbanism as a collective and intentional praxis: to weave, sentipensar, mobilize, reverberate and emancipate. We argue that, put in motion, these pedagogic practices transgress the rules and boundaries of the formal classroom, taking participants to and through other sites and modes of learning that host significant potential to stimulate collectivizing and alternative ways of seeking change towards urban equality.