REGISTRO ITALIANO DELL'EMICRANIA
Piero Barbanti* 1, Licia Grazzi2, Paola Torelli3, Fabrizio Vernieri4, Sabina Cevoli5, Nicola Vanacore6 and on the behalf of the Italian Migrane Registry study group
1Headache And Pain Unit, IRCCS San Raffaele Pisana, Rome, 2Headache Center, Fondazione IRCCS Ist. Nazionale Neurologico Carlo Besta, Milan, 3Headache center, Dep. of Neurological Sciences, Parma, 4Headache Center, Università Campus Bio-Medico, Rome, 5Headache Center, IRCCS Ist. Scienze Neurologiche, Bologna, 6National Centre For Disease Prevention And Health Promotion, National Institute of Health, Rome, Italy
To update the findings of the italian IRON Registry, the first chronic migraine (CM) registry worldwide, which is aimed to disentangle the diverse endophenotypes of CM, optimize its ascertainment, favor a shared clinical management strategy and rationalize healthcare resource use.
All consecutive CM patients seen at 22 Italian headache centers were enrolled. 406 items on socio-demographic factors, life-style, migraine features before and after chronicization, comorbidities and healthcare resource use were gathered by specificallytrained neurologists via face-to-face interviews and shared a web-based platform.
774 CM patients were enrolled, the interim analysis was conducted on 637 individuals. The majority of patients were females (83.1%), mean age of 46.8+12.9 yrs and a mean monthly headache frequency of 26.9±16.4 days. Migraine started at 17.6±9.3 yrs, chronicization at 27.6±7.4 yrs and the first headache specialist consultation at 36.3±13.0 yrs. 70% of patients were on migraine prophylaxis, only 20.6% of them when migraine was episodic. The mean n.of preventive treatments per patient was 1.84±1.9.
Analgesic overuse was present in 57.9% of cases, detoxification in 33.1% of patients, effective only in 17.6%. Symptoms of peripheral trigeminal sensitization were common: unilateral headache (48.4%), pulsating (55.0%), associated with vegetative symptoms (73.8%) and unilateral cranial autonomic symptoms (31.1%). Almost 80% had consulted >2 headache centers. 77.2% of patients underwent >1 investigation-frequently inappropriate (48%)-and generally (57.8%) charged to the national health system (NHS). During the previous year, 18.7% of patients were admitted to the ED; lifetime hospitalization for migraine was 18.5%, for DH 16.8%, mean n.of specialists consultations was 9.22 ±16.86 per patient.
The IRON registry shows the presence of symptoms of peripheral trigeminal sensitization in CM; a substantial delay between age at migraine chronicization and headache center consultation; a relatively low n. of prophylaxis tried by patients; a large number of inappropriate diagnostic procedures, mostly charged at the NHS