Part A – Migraines

Text A

Title: Management of migraine in New Zealand General Practice Authors: Spark, Vale & Mills (2006)

Objectives

To determine the proportion of patients who have a diagnosis of migraine in a sample of New Zealand general practice patients, and to review the prophylactic and acute drug treatments used by these patients.

Design, setting and participants

A cohort of general practitioners collected data from about 30 consecutive patients each as part of the BEACH (Bettering the Evaluation and Care of Health) program; this is a continuous national study of general practice activity in New Zealand. The migraine sub-study was conducted in June-July 2005 and December 2005-January 2006.

Main outcome measures

Proportion of patients with a current diagnosis of migraine; frequency of migraine attacks; current and previous drug treatments; and appropriateness of treatment assessed using published guidelines.

Results

191 GPs reported that 649 of 5663 patients (11.5%) had been diagnosed with migraine. Prevalence was 14.9% in females and 6.1% in males. Migraine frequency in these patients was one or fewer attacks per month in 77.1% (476/617), two per month in 10.5% (65/617), and three or more per month in 12.3% (76/617) (missing data excluded). Only 8.3% (54/648) of migraine patients were currently taking prophylactic medication. Patients reporting three or more migraines or two migraines per month were significantly more likely to be taking prophylactic medication (19.7% and 25.0%, respectively) than those with less frequent migraine attacks (3.8%) (P < 0.0001). Prophylactic medication had been used previously by 15.0% (96/640). The most common prophylactic agents used currently or previously were pizotifen and propranolol; other appropriate agents were rarely used, and inappropriate use of acute medication accounted for 9% of “prophylactic treatments”. Four in five migraine patients were currently using acute medication as required for migraine, and 60.6% of these medications conformed with recommendations of the National Prescribing Service. However, non-recommended drugs were also used, including opioids (38% of acute medication).

Conclusions

Migraine is recognised frequently in New Zealand general practice. Use of acute medication often follows published guidelines. Prophylactic medication appears to be underutilised, especially in patients with frequent migraine. GPs appear to select from a limited range of therapeutic options for migraine prophylaxis, despite the availability of several other well documented efficacious agents, and some use inappropriate drugs for migraine prevention.

Text B

Table 1: Economic burden of migraine in the USA

TEXT C

Case studies: migraine sufferers and work

Case 1:

“Jane” experienced pressure from employers due to her migraine absences. She had three days off work in the first quarter of the year, and this was deemed unacceptable and unsustainable by her employers; therefore she has just resigned from her job and hopes that her future employers will be more understanding.

Case 2:

“Sally’s” employers and colleagues are aware of her migraine symptoms and are alert to any behaviour changes which might indicate an impending attack. In addition, colleagues have supporters’ contact numbers, should she need to be escorted during a migraine. As her employers are part of the government ‘Workstep Programme’, she has accessed a number of allowances and initiatives: her migraines have been classified as a long-term health condition rather than sickness absence, which permits her a higher absence threshold. She now works flexible hours and has received funding for eye examinations, prescription glasses, and a laptop to enable her to work from home.

Text D

Research brief on migraines in the US.

• Migraine prevalence is about 7% in men and 20% in women over the ages 20 to 64.
• The average number of migraine attacks per year was 34 for men and 37 for women.
• Men will need nearly four days in bed every year. Women will need six. The average length of bedrest is five to six hours.
• Only about 1 in 5 sufferers seek help from a doctor.

Questions 1-7

For each question, 1-7, decide which text (A, B, C or D) the information comes You may use any letter more than once. In which text can you find information about.

1. US expense 5446 million US & to treat the migraine in women.
2. The average length of bed rest is 5-6 hours.
3. Migraine prevalence is about 20% in women over the ages 20-64.
4. The migraine sub study was conducted in January 2006 in New Zealand.
5. Women needs 6 days in bed yearly to manage migraine
6. Prophylactic medication has been used previously by 15.0%.
7. Four in five patient using acute medication for migraine.

Questions 8-14

Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may include words, numbers or both. Your answers should be correctly spelt.

1. How many patients were studied in the sparks programme?
2. The average length of bed rest to treat migraine?
3. What are the prophylactic agents used frequently?
4. How much does the USA spend on migraine?
5. How many migraine sufferers seek medical help?
6. What are the non-recommended drugs used by the migraine patient?
7. What is the prevalence of migraine in females in the study conducted In 2006?

Questions 15-20

Complete each of the sentences, 15-20, with a word or short phrase from one of the texts.

Each answer may include words, numbers or both. Your answers should be correctly spelt.

1. By contrast, the study found that a large proportion of migraine sufferers used __________.
2. The case of ___________________ demonstrates that employers may not tolerate.
3. Migraine incidence was different across genders, with a __________ proportion of men diagnosed umpired in women
4. Being able to work ___________ hours and having capacity to work at home makes working life more manageable.
5. Of the patients surveyed by spark, just over 8% were taking ______________ at the time of study.
6. Concerning interventions, the US report found that most migraine sufferers in the survey _________ medical practice.

End of part A | This text booklet will be collected.