The Burden of Migraine in Real Clinical Practice: Clinical and Economic Aspects

Objectives. To assess the value of using different treatment schemes in chronic migraine by comparing clinical results and the economic burdens of disease in real clinical practice. Materials and methods. The study included 66 patients attending the Academician Aleksandr Vein Headache and Autonomic Disorders Clinic: 60 women and six men aged 28–51 years with diagnoses of chronic migraine. The patients were divided into three groups: group 1 ( n = 22) consisted of patients who received three months of oral prophylactic therapy with topiramate at doses of up to 100 mg/day; patients of group 2 ( n = 20) received 12 sessions of acupuncture with three procedures per week; patients of group 3 ( n = 24) received injections of botulinum toxin type A (Botox, BTA) at a dose of 155–195 U. The observation period was three months. Treatment efficacy was assessed using the following methods: clinical-neurological assessment, the Headache Impact Test HIT-6 questionnaire, and a subjective points questionnaire assessment for treatment satisfaction and tolerance. Results. BTA was the most effective of the three treatment methods studied in patients with chronic migraine. As compared with oral prophylactic therapy and acupuncture, BTA produced the fastest and strongest actions on the frequency of headache, promoting regression of chronic migraine and recovery of the episodic nature of headache (the numbers of headache days in group 1, 2, and 3 were 16.1 ± 0.1, 18.0 ± 0.02, and 13.9 ± 0.3, respectively, at one month). BTA also produced significantly faster and more effective recovery of quality of life and was better tolerated (good in 51%, 75%, and 85% in groups 1, 2, and 3, respectively; satisfactory in 35%, 25%, and 15% in groups 1, 2, and 3, respectively; poor in 14% in the oral prophylaxis group). Most patients in the BTA group achieved satisfactory treatment results more quickly. Despite the greater direct costs as compared with topiramate, the direct costs associated with the use of BTA (29931.51 and 32085.87 rubles, respectively, the predicted cost per non-headache day in the BTA group was the lowest, at 652.15 rubles (692.86 and 1017.60 rubles in the oral prophylaxis and acupuncture groups, respectively). Conclusions. The efficacy and cost data obtained here for the different methods of prophylaxis of chronic migraine may help specialists and patients select the most optimal therapeutic approaches.