Workshop + next steps, CEEAM IstanbulSeptember 21, 2007

Migraine in CEE countries :Summary + conclusions

• Population of ca. 175 M (w/o CIS) • Different medical systems, economic level • General price sensitivity of patients

Country description

Health care system

• Triptans – the most effective treatment – are usually at least partly reimbursed

• Often, reimbursement only with NEU approval

Q: Is reimbursement a real barrier for adequate treatment?

Is triptan status to be changed ?

Current issues in migraine management

• Diagnostic: – primarily at NEU– Somewhere mandatory NEU exam. before triptans– Easy to use dg. tool ?

• Therapy: – Primary care vs. specialist– guidelines- existing/implemented ?

• Barriers– Awareness: patient, GP, NEU– Headache vs. Migraine ? (GP, patients)– Triptan price – Availability: Rx vs. OTC

Headache Society, Centers and Specialists: role in migraine management

• Headache society: Established: HU, LT,CZ, BG, LV, TR, PLNone or defunct: EE, RO, SK,

• Influence on treatment: – Guidelines – Reimbursement– NETWORK ? („map of migraine specialists)

• Education („Who can train who ?“)– Own members / specialists– GPs – Patients

• Coordination of international cooperation, EHF…• Awareness creation: whose awareness ?

The role of GPs in migraine management

• Interest ?• Capacity ? • Education

– Skill + knowledge– Tools (test)

• Support by guidelines

Common issues

• Awareness– Patients– GPs

• Education• Guidelines• System:

– GP role,referral systém– Status of triptans (NEU only; reimbursement)– Price of treatment

Migraine awareness : now

1. Specialists:• May underestimate QoL issue• are they contacted by the patients ?

2. Patients: • Mostly go for self-medication (symptomatic)• Do not know about „curability“ of migraine

3. GPs: • are not addressed – „no patients“• no motivation to solve accidental complaints• May lack knowledge fo advice /act

The migraine awareness: future

1. Patients: • Knowledge of disease, of its curability• Pathways established (where to ask)

2. GPs: – primary contact, – screening role ?– treatment incl. Triptans ?

3. Specialists: • referral for diff. Dg if necessary• Refractory cases + profylaxis

Do we (CEEAM) want to help? Can we help ?

• Structure

• Country champions

• Communication platform

• Meeting schedule

• Projects:– Discuss now !

CEEAM projects (possible) :

1. Guidelines – transfer + sharing

2. Exchange of contacts, sharing ideas online

3. Education: local vs. International events1. for neurologists

2. For primary care

4. PR: Days of migraine

5. Epidemiology of migraine

6. pharmacoeconomy

International contact point CEEAM

• Simple tool: www.ceeam.info

• Education platform: training scheme

• Transfer of guidelines

• Epidemiologic data

• PR – days against migraine

CEEAM projects next steps

1. Guidelines – transfer + sharing: Existing guidelisens (CZ, PL, TR) will be translated and published on CEEAM web for reference

2. Exchange of contacts, sharing ideas online: webpage active by mid-October 2007, passwords available to participants

3. Education: local vs. International events1. for neurologists: best way = support( stipends) for exisiting EHF and IHS

events – e.g. Summer schools2. For primary care: done locally, CEEAM may build an international

curriculum for such course. Priority for 20084. PR: Days of migraine: to be done locally, Zentiva committmen to

support 5. Epidemiology of migraine: Zentiva Industry sponsored NCT to be

published 2008 in Krakow (WONCA) 6. Pharmacoeconomy: considered very important but postponed until

next year