Prophylactic treatment of migraine; the patient's view, a qualitative study
1 Leiden University Medical Center, Public Health and Primary Care, Postzone VO-P, P.O. Box 9600, 2300, RC Leiden, the Netherlands
2 Headache Lead, Royal College of General Practitioners, London, UK
3 Amsterdam Institute for Social Science Research University of Amsterdam, Amsterdam, the Netherlands
4 Neurology LUMC, Leiden, the Netherlands
BMC Family Practice 2012, 13:13 doi:10.1186/1471-2296-13-13Published: 9 March 2012
Prophylactic treatment is an important but under-utilised option for the management of migraine. Patients and physicians appear to have reservations about initiating this treatment option. This paper explores the opinions, motives and expectations of patients regarding prophylactic migraine therapy.
A qualitative focus group study in general practice in the Netherlands with twenty patients recruited from urban and rural general practices. Three focus group meetings were held with 6-7 migraine patients per group (2 female and 1 male group). All participants were migraine patients according to the IHS (International Headache Society); 9 had experience with prophylactic medication. The focus group meetings were analysed using a general thematic analysis.
For patients several distinguished factors count when making a decision on prophylactic treatment. The decision of a patient on prophylactic medication is depending on experience and perspectives, grouped into five categories, namely the context of being active or passive in taking the initiative to start prophylaxis; assessing the advantages and disadvantages of prophylaxis; satisfaction with current migraine treatment; the relationship with the physician and the feeling to be heard; and previous steps taken to prevent migraine.
In addition to the functional impact of migraine, the decision to start prophylaxis is based on a complex of considerations from the patient's perspective (e.g. perceived burden of migraine, expected benefits or disadvantages, interaction with relatives, colleagues and physician). Therefore, when advising migraine patients about prophylaxis, their opinions should be taken into account. Patients need to be open to advice and information and intervention have to be offered at an appropriate moment in the course of migraine.