Patients’ Experiences During the Long Journey Before Initiating Migraine Prevention with a Calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibody (mAb)
Elizabeth Seng, Christian Lampl, Lars Viktrup, William R. Lenderking, Hayley Karn, Margaret Hoyt, Gilwan Kim, Dustin Ruff, Michael H. Ossipov, Maurice Vincent
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Abstract
Introduction
Migraine is under-diagnosed and under-treated. Many people with migraine do not seek medical care, and those who do may initially receive a different diagnosis and/or be dissatisfied with provided care on their journey before treatment with a CGRP-mAb (calcitonin-gene-related-peptide monoclonal antibody).
Methods
This is a cross-sectional, self-reported, online survey of subjects in Lilly’s Emgality® Patient Support Program in 2022. Questionnaires collected insights into subjects’ prior experiences with migraine and interactions with healthcare professionals before receiving CGRP-mAbs.
Results
Of the 250 participants with episodic and 250 with chronic migraine, 90% were female and white with a mean age of 26.2 years (± 11.9) at diagnosis and 40.6 (± 12.0) years at survey enrollment. Many participants (71%) suspected they had migraine before diagnosis, with 31% reluctant to seek help. Of these, approximately one-third were unaware of treatment, did not think that a physician could do anything more for migraine, would not take them seriously, or were reluctant due to a previous unhelpful experience. Participants mainly received information from friends/family (47%) or the internet (28%). Participants initially sought treatment due to an increase in migraine frequency (77%), attacks interfering with work or school (75%), or increased pain intensity (74%). Subjects saw a mean of 4.1 (± 4.3) healthcare providers before migraine diagnosis, and 20% of participants previously received a different diagnosis. Participants reported migraine causes included stress/anxiety/depression (42%), hormonal changes (30%), nutrition (20%), and weather (16%). Acute treatment of migraine included prescription (82%) and over-the-counter (50%) medications, changes in nutrition (62%), adjusting fluid intake (56%), and relaxation techniques (55%). Preventive medications included anticonvulsants (61%), antidepressants (44%), blood pressure-lowering medications (43%), and botulinum toxin A injections (17%). Most discontinuations were due to lack of efficacy or side effects.
Conclusion
People with migraine describe reluctance in seeking health care, and misunderstandings seem common especially in the beginning of their migraine journey.
导言偏头痛诊断不足，治疗不足。许多偏头痛患者并不就医，而那些就医的患者最初可能会得到不同的诊断，并且/或者在接受CGRP-mAb（降钙素基因相关肽单克隆抗体）治疗前对所提供的治疗不满意。结果在250名发作性偏头痛患者和250名慢性偏头痛患者中，90%为女性和白人，确诊时的平均年龄为26.2岁（±11.9）岁，接受调查时的平均年龄为40.6岁（±12.0）岁。许多参与者（71%）在确诊前就怀疑自己患有偏头痛，31%的人不愿寻求帮助。其中，约有三分之一的人不了解偏头痛的治疗方法，认为医生对偏头痛束手无策，不会认真对待他们，或由于以前的无助经历而不愿求助。参与者主要从朋友/家人（47%）或互联网（28%）处获得信息。参与者最初寻求治疗的原因是偏头痛发作频率增加（77%）、发作影响工作或学习（75%）或疼痛强度增加（74%）。在确诊偏头痛之前，受试者平均看了4.1（± 4.3）家医疗机构，20%的受试者之前曾接受过不同的诊断。参与者报告的偏头痛原因包括压力/焦虑/抑郁（42%）、荷尔蒙变化（30%）、营养（20%）和天气（16%）。偏头痛的急性治疗包括处方药（82%）和非处方药（50%）、改变营养（62%）、调整液体摄入量（56%）和放松技巧（55%）。预防性药物包括抗惊厥药（61%）、抗抑郁药（44%）、降血压药（43%）和 A 型肉毒毒素注射（17%）。结论偏头痛患者表示不愿意寻求医疗服务，误解似乎很常见，尤其是在偏头痛初期。
期刊介绍：
Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged.
Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia.
The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.
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