Stability, responsiveness, and reproducibility of a visual analog scale for treatment satisfaction in migraine.

OBJECTIVES: To evaluate the stability, responsiveness, and reproducibility of a simple visual analog scale (VAS). BACKGROUND: In order to help physicians in the management of migraine in everyday general practice and assess whether the treatments that they are currently prescribing are actually effective, a VAS of treatment satisfaction with acute migraine treatments has been developed. METHODS: The study used an open-label, multicenter, prospective design. Adult patients fulfilling diagnostic criteria for migraine and who consulted a participating hospital or community neurology clinic were eligible. At inclusion, patients rated their satisfaction with their current treatment on the VAS. Those scoring 7-10 (satisfied) on the VAS were allocated to the VASCO cohort, and those scoring 0-4 (dissatisfied) were switched to almotriptan and allocated to the ALMO cohort. Patients scoring between 4 and 7 were assigned to 1 or other cohort at the physician's discretion. The VAS was re-administered at home the next day and also after the treatment of 3 further headaches, both at home and at a follow-up visit. RESULTS: Ninety-eight patients in the VASCO cohort and 102 in the ALMO cohort were analyzed. Stability was evaluated in the VASCO cohort: 55/98 patients initially satisfied with treatment remained so at study end, whereas 7/98 became dissatisfied. Responsiveness of the VAS to a change in treatment was evaluated in the ALMO cohort: 64/102 patients moved to a higher treatment satisfaction category, whereas 6/102 moved to a lower one. Reproducibility of the VAS was determined in 4 settings (both at the inclusion visit and at study closure in both cohorts). In each setting, VAS scores were compared between consultation and at-home ratings. In 3 of the 4 settings (both measures in the ALMO cohort and at study closure in the VASCO cohort), good agreement was observed between the 2 ratings (κ = 0.62-0.69). At inclusion in the VASCO cohort, agreement was only fair (κ = 0.33). CONCLUSIONS: The VAS scale described here is a responsive and easy-to-use tool for evaluating treatment satisfaction and for monitoring changes to treatment if these are required.

Use of antimigraine treatments by general practitioners.

OBJECTIVES: To assess headache treatment patterns in 2 groups: general practitioners (GPs) who suffered from migraine themselves (GP-M) and GPs having a close family member with migraine (GP-CFM). The secondary objective was to assess the impact of migraine on activities of daily living in these 2 groups. BACKGROUND: Personal experience of migraine may influence prescribing practices of physicians treating patients with migraine. Little data are available on perceptions of migraine by GPs. METHODS: This was an observational, cross-sectional, pharmacoepidemiological survey conducted in primary care in France. Most GPs completed 1 of 2 questionnaires, and GPs belonging to both groups could complete both. Data were collected on headache treatments used (GP-M) or prescribed (GP-CFM), and on self-reported (GP-M) or described (GP-CFM) migraine features and impact on daily activities. RESULTS: The most frequently reported acute headache treatments in both groups were triptans and non-steroidal anti-inflammatory drugs (>75% of GPs); >81% of GPs in both groups were satisfied with acute headache treatments. Only 6.9% of the GP-M group used and 17.2% of the GP-CFM group prescribed a prophylactic treatment, which was considered satisfactory by 46.2% and 56.1%, respectively. In the preceding 3 months, 79.4% of the GP-M group reported handicap in daily activities due to migraine, 23.6% interruption of extraprofessional activities and 7.6% interruption of work. In the GP-CFM group, 32.6% described interruption of extraprofessional activities and 57.3% interference with daily activities or work. CONCLUSIONS: Acute headache treatment prescribed by French GPs for their own migraines or those of their relatives respect practice guidelines and is considered as effective and satisfactory. Use of prophylactic medication is low and its effectiveness perceived as limited. Better use of prophylactic treatments may attenuate the impact of migraine on daily activities.

An instrument to assess patient perceptions of satisfaction with acute migraine treatment (EXPERT Study).

OBJECTIVE: The objective of the nationwide EXPERT survey carried out in France in 2005 was to compare satisfaction with treatment with treatment effectiveness in migraine patients consulting general practitioners (GPs) for migraine, and to establish an instrument to easily evaluate the adequacy of acute treatment of migraine. BACKGROUND: Many migraine patients feel satisfied with their current acute treatment of migraine whereas objective evaluation reveals poor treatment effectiveness. METHODS: A total of 2108 GPs included 11,274 migraine patients. Satisfaction with treatment was evaluated using a 4-point verbal scale and a 10-cm visual analog scale (VAS). Treatment effectiveness was assessed by the 4-item questionnaire designed by the French Medico-Economic Evaluation Service (ANAES) and the French Society for the Study of Migraine Headache (SFEMC). RESULTS: In total, 5224 patients (49.8%) stated that they were satisfied with their treatment. Mean VAS score was 5.1. Only 17% of patients (1789/10,539) gave positive responses at the 4 questions of the ANAES/SFEMC questionnaire. VAS score was high for patients satisfied with their treatment and with good treatment effectiveness. Two VAS thresholds were determined using receiver operating characteristic curves that allowed easy identification, with high sensitivity and specificity, of patients satisfied/dissatisfied with their current treatment and with good/poor treatment effectiveness. Based on EXPERT data, this instrument showed that only 16% of patients using triptans (597/3719) were dissatisfied and reported poor treatment effectiveness, whereas treatment was inadequate for 63% of those using aspirin or nonsteroidal anti-inflammatory drugs (1882/2992), 74% of those using paracetamol or other analgesics (2229/2998), and 53% of those using ergotamine (253/474). CONCLUSIONS: The new instrument should allow easy identification in general practice of the patients receiving an effective or ineffective acute treatment of migraine and thus facilitate the implementation of treatment guidelines for migraine.