The GRIM2005 study of migraine consultation in France. III: Psychological features of subjects with migraine.

The objective of this analysis was to describe psychological and cognitive variables in subjects with migraine and to identify those associated with chronicity. Data were collected from 10 000 subjects during face-to-face interview. Subjects with episodic migraine (n = 1127) or chronic daily headache (n = 407) with migrainous features were identified using an algorithm based on the International Classification of Headache Disorders, 2nd edn classification. Data on headache impact was obtained with the Headache Impact Test-6, on psychological distress with the Hospital Anxiety and Depression Scale, on coping with the Coping Strategy Questionnaire catastrophizing score and the Brief COPE inventory, on illness perception with the Brief Illness Perception Questionnaire and on locus of control. Psychological variables associated with chronicity include perceived headache impact, psychological distress, the use of catastrophizing and avoidance coping strategies and an externalized locus of control. In conclusion, maladaptive coping strategies should be taken into account in the management of patients with migraine. Longitudinal studies will be necessary to address the causality of the relationship observed.

Prevalence of diagnosed type 2 diabetes mellitus in the French general population: the INSTANT study.

AIMS: To estimate the prevalence of diagnosed type 2 diabetes mellitus in the French general population. Secondary objectives were to evaluate treatments and diabetic complications. METHODS: In this cross-sectional epidemiological survey, a representative sample of the French adult population was selected using a stratified quota method: 10,038 individuals were evaluated by a standardized face-to-face interview. The diagnosis of type 2 diabetes was determined on the basis of replies to six questions using a specific algorithm. Data were collected on risk factors, diabetes history, familial antecedents and diabetic complications. These patients also identified their treatments from an exhaustive list. RESULTS: The prevalence of type 2 diabetes was 5.08% in men and 4.11% in women, and rose progressively after the age of 50. Of these, 79 patients (13.4%) received no pharmacological treatment, 477 (80.9%) were taking an oral antidiabetic drug and 134 (22.7%) were taking insulin. Renal and ocular complications were reported by 6.8% and 21.0%, respectively, of the patients. Also, 10.4% had been hospitalized at some time of that year for a diabetes-related problem. The most frequently reported treatments were metformin and sulphonylureas, used by more than 50% of the patients. In addition, 380 patients (65.9%) claimed to be following a diet and 228 (39.2%) were consulting a dietitian. CONCLUSION: The prevalence of treated and untreated type 2 diabetes mellitus in France was 4.57%.

Clinical features of primary headache in children: a multicentre hospital-based study in France.

The aim of this study was to evaluate the concordance between clinical diagnosis and the International Classification of Headache Disorders, 2nd edn (ICHD-II) in children and adolescents with primary headaches. This 6-month prospective multicentre study of 486 patients (mean 9.8 +/- 3.1 years; 52.6% girls) assessed the headache features through a structured questionnaire. In 398 patients with a single type of headache, headaches were bilateral (78.1%), frontal (62.4%), pulsatile (56.1%), with associated symptoms in 84.4%. The most frequently assigned diagnoses were migraine without aura (50.8%), probable migraine (14.1%), migraine with aura (11.1%) and frequent episodic tension-type headache (7.5%). For most of the diagnostic categories, the consistency of the investigator's diagnosis with the ICHD-II criteria was good (kappa > 0.6 and < or = 0.8) or excellent (kappa > 0.8). We conclude that migraine was predominant with regard to headache diagnoses repartition and that the ICHD-II seems usable in practice for evaluation of primary headache in French children and adolescents.

The GRIM2005 study of migraine consultation in France II. Psychological factors associated with treatment response to acute headache therapy and satisfaction in migraine.

The objective of this analysis was to identify variables associated with treatment response in subjects with migraine. Data were collected from a sample of 10,000 subjects. A battery of questionnaires assessing clinical and psychological variables was completed. Migraine diagnosis was attributed using an algorithm based on the IHS criteria and treatment response using the ANAES criteria. We identified 1534 subjects, of whom 1443 were treated. For 54.2%, at least one ANAES criterion for treatment response was unfulfilled. Non-response was associated with female gender, high HIT-6 impact scores and high HAD psychological distress scores. The strongest associations with non-response were identified for four psychological variables: elevated scores on the CSQ catastrophization subscale and the 'Consequences' and 'Acceptance' dimensions of the Brief COPE, and low scores on the 'Positive Reinterpretation' Brief COPE dimension. In conclusion, many individuals with migraine respond inadequately to treatment. Behavioural interventions aimed at modifying coping strategies may improve outcome.

The GRIM2005 study of migraine consultation in France I. Determinants of consultation for migraine headache in France.

The aim of this study was to evaluate determinants of consultation for migraine in a representative sample of the French general adult population. We interviewed 10,032 subjects, of whom 1534 fulfilled the International Headache Society diagnostic criteria for migraine. These were categorized into migraine, probable migraine and chronic migraine. Information was collected on consultation experience; 436 subjects (28.4%) had never consulted for headache, 473 (30.8%) were in active consultation and 625 (40.7%) had previously consulted but lapsed. Subjects with chronic migraine showed the highest active consultation rates (51.8%). All subjects completed rating instruments for headache [Headache Impact Test (HIT)-6], psychiatric (Hospital Anxiety and Depression Scale scale) and psychological [Brief Illness Perception Questionnaire (BIPQ), Brief COPE Inventory and Coping Strategy Questionnaire] variables. The strongest determinants of active consultation were BIPQ scores, HIT-6 scores and migraine type. Consultation was associated with maladaptive coping strategies (social support, emotional expression and acceptance). Determinants of remaining in consultation were catastrophizing coping scores and previous consultation experience.

[Migraine in general practice. A French multicenter study]. / Prise en charge de la migraine en médecine générale. Une étude multi-centrique française.

INTRODUCTION: A national survey has been conducted with 349 general practitioners in order to analyze the management of concerned episodic headache in general practice. METHOD: This survey enabled collection of data from 2537 headache patients. The main data concered IHS diagnosis, severity of headache using the MIGSEV scale, management, practices and the impact on daily living (QVM and HIT-6 scales). RESULTS: Out of the 2537 included patients, 52 percent were migraine sufferers according to IHS criteria (code 1.1/1.2), 34 percent presented with migrainous disorders (code 1.7), and 14 percent were non-migraine headache patients. The distribution of management practices showed that 71 percent of them were given non-specific treatments, 46 percent of them specific treatments and 27 percent of them prophylactic treatments. Analysis of the impact of headache using the QVM or the HIT-6 demonstrated a relationship between diagnosis, migraine severity and disability. Analysis of the correlation between the severity of the last migraine attack as evaluated by the patient and that estimated by the doctor showed that the practitioner tended to underestimate the patient's pain. These results highlight the importance of communication between practitioners and migraine sufferers. CONCLUSION: Training of general practitioners in the use of simple tools such as the HIT-6 scale, should be helpful for a better evaluation of the impact of headache on daily living, and hence should lead to more optimal therapeutic management of headache patients.

Use of the headache impact test (HIT-6) in general practice: relationship with quality of life and severity.

To assess the global impact of episodic headaches in patients consulting general practitioners (GPs) using the Headache Impact Test (HIT-6) questionnaire, and to compare this with measures of headache severity and quality of life. A total of 2802 patients consulting 349 GPs participated to this cross-sectional study. Data were collected on headache severity using the Migraine Severity (MIGSEV) scale, headache impact with the HIT-6 and quality of life with the Qualité de Vie et Migraine (QVM) questionnaire. Diagnosis was assigned retrospectively according to the International Headache Society criteria. The association between the HIT-6 scale and the other scales was determined from a Pearson's chi-square test, an analysis of variance and Spearman correlation coefficients. Patients (2537) provided exploitable data. Six percent of the sample had little impact, 14% moderate, 14% substantial and 66% severe impact. The HIT-6 scores were significantly different between diagnostic groups, being highest in the migraine group. The HIT-6 score were well correlated with headache severity and QVM score. The HIT-6 scale correlates, across different diagnostic groups of headache, with both headache severity and with quality of life.

Variability of reported headache symptoms and diagnosis of migraine at 12 months.

Assignment of a diagnosis of migraine has been formalized in diagnostic criteria proposed by the International Headache Society. The objective of the present study is to determine the reproductibility of the formal diagnosis of migraine in a cohort of headache sufferers over a one-year period. The study was performed in a community cohort taking part in a long-term prospective health survey, the GAZEL study. Two thousand five hundred individuals reporting headache in the GAZEL cohort were sent two postal questionnaires concerning headache symptoms and features at 12-monthly intervals. Replies to the questions allowed a migraine diagnosis to be attributed retrospectively using an algorithm based on the IHS classification scheme. The response rate was 82% for the first questionnaire and 69% for both questionnaires. Of the 1733 subjects providing information at both time-points, the agreement rate for the diagnosis of strict migraine (IHS categories 1.1 or 1.2) was 77.7% (kappa = 0.48), with 62.2% of the patients with this diagnosis (IHS categories 1.1 or 1.2) at Month 0 retaining the same diagnosis at Month 12. When diagnostic criteria were widened to include IHS category 1.7 (migrainous disorder), the agreement rate of the diagnosis was similar at 77.6% (kappa = 0.52), but 82% of the patients with this diagnosis (IHS categories 1.1 or 1.2 or 1.7) at Month 0 now retained the same diagnosis at Month 12. In conclusion, the one-year reproducibility of reporting of migraine headache symptoms is only moderate, varies between symptoms, and leads to instability in the formal assignment of a migraine headache diagnosis and to diagnostic drift between headache types. This finding is compatible with the continuum model of headache, where headache attacks can vary along a severity continuum from episodic tension-type headaches to full-blown migraine attacks.

[NOEMIE: an epidemiological study of migraine at work: results from 17 occupational health centres]. / NOEMIE: un observatoire de la migraine en entreprise. Résultats obtenus dans dix-sept centres de médecine du travail.

INTRODUCTION: A survey (NOEMIE, Nouvel Observatoire Epidemiologique de la Migraine en Entreprise) was carried out in France in 17 occupational healthcare units in order to identify subjects suffering from migraine headache with the aim of guiding them towards a healthcare program. The data collected in the participating units are presented. METHODS: and patients. NOEMIE was a national cross-sectional, observational, multicentric study with a 6-month follow-up. Two groups of migraine sufferers (according to IHS criteria) were included and divided into two groups: subjects already managed for their migraine (group A) and subjects who had not sought healthcare for migraine for more than 12 months (group B). The main objective was to evaluate changes in the quality-of-life score (QVM) 6 months later. RESULTS: At inclusion, the two groups were comparable for demographic features, history of migraine, and disease severity. A significant difference was observed between the two groups for frequency of attacks, disease management, and evaluation of treatment efficacy and of quality-of-life. At 6 months, patient satisfaction and quality-of-life were significantly improved (6 to 10 point improvement). For the 4753 reported attacks, 12.4 percent of the patients in group A required sick leave versus 10.9 percent in group B. Frequency of sick leave was considerably improved in both groups. CONCLUSION: By identifying subjects suffering from migraine headache who had not sought specific medical care and advising them to seek medical management, the employee healthcare units improved the subjects' quality-of-life, promoted adequate medical management and reduced occupational consequences of migraine headache.

[The treatment of migraine by pharmacists: a French multicenter study]. / La migraine en pharmacie d'officine: une étude multi-centrique française.

Migraine remains an under-diagnosed disease. Many migraine sufferers are not currently treated within the healthcare system and most of them take self-medication. A prospective national study was conducted in France with 770 pharmacies. Data on symptoms, drug dispensing, patient management, and satisfaction of 7 264 subjects complaining of headache at the pharmacy were collected. Two-third of the subjects were migraine sufferers according to the IHS criteria. 32 p. cent of them came to the pharmacy during a pain attack. 63 p. cent had a medical prescription (46 p. cent in the non-migraine group) with triptans being most often prescribed drug (in almost half of the cases). Nearly one-third of the migraine sufferers without medical prescription were referred to a doctor by the pharmacist. This first study on migraine and headaches and pharmacies highlights the important role that pharmacists can play in improving the management of migraine and headache through advice and proper orientation towards medical practitioners.

Assessment of migraine severity using the MIGSEV scale: relationship to migraine features and quality of life.

We have recently developed an instrument to describe and categorize severity of migraine attacks from patient self-report, the MIGSEV questionnaire. We have now performed a large prospective survey using this tool to evaluate migraine severity in 2979 patients consulting for headache in France, included by 1164 general practitioners, 174 neurologists and 82 gynaecologists. The objective of the study was to determine the prevalence of severity grades in a large population who consults for migraine, to test the concordance between severity calculated from physician-derived and patient-derived data, and to test the relevance of the concept of severity as applied to diagnosis, other measures of the burden of migraine, and to health-related quality of life. Severe attacks were reported in around one-fifth of the sample. Physician- and patient-derived data provided concordant estimates of severity in 71% of cases, the discordant cases representing principally an underestimate by the physician of headache severity. Migraine severity was associated with frequent, long-lasting and treatment-resistant attacks, and with poor quality of life. The MIGSEV questionnaire is proposed as a simple measure of severity for the diagnosis and management of migraineurs, suitable for use both by physicians and patients.