[Influence of general practitioners' personal knowledge on migraine in medical attitudes towards their patients suffering from migraine]. / Influence de la connaissance personnelle de la migraine par l'omnipraticien sur la prise en charge de ses patients migraineux.

The subjective aspects of the doctor-patient relationship may impact disease management methods applied to migraine patients. This prospective study compared the medical attitudes of doctors towards migraine headache in relationship to their personal sensitivity to this disease. The study concerned data on the health care management of migraine headache by 711 general practitioners, 325 of whom suffer from migraine headache themselves, 227 who do not suffer from migraines, but who have a close family member that does, and 159 who neither suffer from migraine headache, nor have anyone close who does. Each doctor filled out a medical practice questionnaire concerning this pathology and included one migraine patient in the survey. Each patient answered a specific quality of life questionnaire. It was shown that doctors suffering from migraine headache themselves declared having more migraine patients in their practices than the other doctors. Nonetheless, the doctor's sensitivity to migraine headache does not seem to have an impact on the diagnosis and therapeutic care of patients; diagnosis criteria are the same within the three groups and correspond to international headache society criteria. Furthermore, the therapeutic means applied, whether acute first or second intention treatment, or long-term treatment, do not differ amongst the three groups. Quality of life and patients' feelings about medical support were significantly related to the doctor's level of sensitivity towards the disease: they were highest amongst patients treated by doctors suffering from migraines themselves, and lowest amongst patients treated by doctors with no close family members suffering from migraines. Although therapeutical attitudes do not vary, the quality of life perceived by patients is better when the doctors themselves are concerned by the disease.

[A descriptive analysis of naratriptan use among migraineurs in ambulatory medicine]. / Analyse descriptive des modalités d'usage du naratriptan dans la prise en charge de la migraine en médecine de ville.

The objective of this study was to provide an epidemiological description of naratriptan use in ambulatory medicine. 1695 patients were recruited by 384 primary care physicians and 111 neurologists, and followed for 12 weeks. Physicians had to document the migraine history, and to report symptoms and health care in a structured case report form. Patients were to document each episode of migraine (EM) in a diary. At baseline, 45 p.cent of the patients reported their migraine treatment as unsatisfactory. Ninety-eight percent of included patients were migraineurs according to criteria of the International Headache Society (IHS), including migrainous disorders. Ninety-two percent of naratriptan prescriptions were established in the second intention in patients with migraine, according to the IHS classification, including migrainous disorders. A total of 79 p.cent of patients had complied with the good practices for all EMs. More appropriate health education strategies should target the small group of patients who over-use naratriptan, and patients with aura. However, this study shows that naratriptan tends to be correctly prescribed by physicians, and used by patients with acute migraine.

Evaluating patient satisfaction with specific migraine therapy based on initial treatment expectations: the PAX study.

AIMS AND OBJECTIVES: The PAX study was a naturalistic, prospective survey evaluating treatment expectations and satisfaction in a typical French migraine population. METHODS: A total of 1710 patients were recruited by 489 general practitioners across France. Despite a high drop-out rate (due to one or more deviations from protocol and/or missing data), the analysable per-protocol population (PPP) patients (n = 615) remained representative with regard to the overall migraine population. Patients ranked expectations according to four criteria at baseline, and were asked to report satisfaction for each criterion at baseline and for six consecutive attacks. The highest-ranked treatment expectation was rapid relief of headache, followed by pain-free response, relief of associated symptoms, and ability to carry on present activity, respectively. RESULTS: At inclusion, >50% of patients were using non-specific medications (analgesics, NSAIDs), and 30% reported global satisfaction with treatment. At the end of the survey, >75% of patients were using specific medications (predominantly triptans), and global treatment satisfaction increased to 83%, independent of treatment expectation rankings at baseline. CONCLUSIONS: These survey results suggest that satisfaction with acute migraine treatment increases when specific medications are prescribed, irrespective of which treatment expectation is considered most important at baseline. This emphasizes the need for improvements in the management of migraine, to ensure that optimal treatment is being provided with regard to pharmacological intervention.