Background: Many different preventatives have showed efficacy in the treatment of migraine. National guidelines\ndiffer in their recommendations and patientsâ?? characteristics are usually taken into account in their selection. In\nSpain, real life use of preventive therapies seems to be heterogeneous. We aimed to evaluate differences in clinical\npractice and adherence to national guidelines among Spanish neurologists.\nMethods: Observational descriptive study. A survey was conducted among neurologists ascribed to the Spanish\nSociety of Neurology. Participants were differentiated in accordance with their dedication to headache disorders.\nWe analysed socio-demographic parameters and evaluated 43 questions considering migraine management as well\nas therapeutic choices regarding migraine sub-types and finally, neurologistsâ?? personal perception.\nResults: One hundred fifty-five neurologists participated from 17 different regions, 43.4% of them female and 53.3%\nunder 40 years of age. 34.9% confirmed headache disorders as their main interest.\nThe first choice for preventive therapy in chronic migraine among participants was topiramate (57%) followed\nby amytriptiline (17.9%) and beta-blockers (14.6%). However in episodic migraine, the preferred options were\nbeta-blockers (47.7%), topiramate (21.5%) and amytriptiline (13.4%). Regarding perceived efficacy, topiramate\nwas considered the best option in chronic migraine (42.7%) followed by onabotulinumtoxinA (25.5%) and\namitryptiline (22.4%). Where episodic migraine was concerned, surveyed neurologists perceived topiramate (43.7%) and\nbeta-blockers (30.3%) as the best options. When we evaluated the duration of treatment use with a view to adequate\ntherapeutic response, 43.5% of neurologists preferred 3 months duration and 39.5% were in favour of 6\nmonths duration in episodic migraine. However, considering the preferred duration of treatment use in\nchronic migraine, 20.4% recommended 3 months, 42.1% preferred 6 months and 12.5% and 22.4% opted\nfor 9 and 12 months respectively. When considering onabotulinumtoxinA therapy, the number of prior\ntherapeutic failures was zero in 7.2% of neurologists, one in 5.9%, two in 44.1%, three in 30.9% and four\nor more in 11.9%. Following an initial treatment failure with onabotulinumtoxinA, 49% of subjects decided against a second\ntreatment. The number of OnabotA procedures before considering it as ineffective was two in 18.9% of neurologists, three\nin 70.8% and four in 10.4%.\nConclusions: The initial management of migraine among Spanish Neurologists is in line with most guidelines, where first\nchoice preventative drugs are concerned. The Management of episodic migraine differed from chronic migraine, both in\nterms of neurologist preference and in their perceived efficacy.
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