Table 1.
Criteria for traversing barriers to care by country
| Barrier | Criteria | |||||
|---|---|---|---|---|---|---|
| US | Canada | Germany | France | UK | Japan | |
| Appropriate current consultera | GP, family physician, or IM doctor | GP, family physician, or IM doctor | GP, family physician, or IM doctor | GP, family physician, or IM doctor | GP, family physician, or IM doctor | GP, family physician, or IM doctor |
| NP or PA | NP or PA | NP or PA | - | Clinical NP | - | |
| Allergist | Allergist | Allergist | Allergist | Allergist | Allergist | |
| ENT | ENT | ENT | ENT | ENT | ENT | |
| Headache specialist | Headache specialist | Headache specialist | Headache specialist | Headache specialist | Headache specialist | |
| Neurologist | Neurologist | Neurologist | Neurologist | Neurologist | Neurologist | |
| Ob-Gyn | Ob-Gyn | Ob-Gyn | Ob-Gyn | Ob-Gyn | Ob-Gyn | |
| Pain specialist | Pain specialist | Pain specialist | Pain specialist | Pain specialist | Pain specialist | |
| - | Ophthalmologistb | - | Ophthalmologistb | Ophthalmologistb | Ophthalmologistb | |
| Psychiatrist | Psychiatrist | Psychiatrist | Psychiatrist | Psychiatrist | Psychiatrist | |
| - | PM&R physicianb | - | - | - | - | |
| - | - | Orthopedic physicianb | Orthopedic physicianb | - | - | |
| - | - | - | Rheumatologist | - | - | |
| Accurate diagnosis |
< 15 MHDs, diagnosis = migraine or menstrual migraine ≥ 15 MHDs, diagnosis = chronic migraine or transformed migraine |
|||||
| Appropriate treatmentc | Acute treatment (for any respondent with a diagnosis of migrained) | |||||
| NSAID | NSAID | NSAID | NSAID | NSAID | NSAID | |
| Triptan | Triptan | Triptan | Triptan | Triptan | Triptan | |
| Ergotamine | Ergotamine | Ergotamine | Ergotamine | Ergotamine | Ergotamine | |
| Isometheptene | - | - | - | Isometheptene | - | |
| Ditane | - | - | - | - | Ditane | |
| Gepantf | - | - | - | Gepantf | - | |
| - | - | - | Combo Rxg | - | - | |
| - | - | - | - | - | Other Rx analgesich | |
| Preventive treatment (AHS Consensus Statement used to define need for preventive treatmenti) | ||||||
| Anti-seizure | Anti-seizure | Anti-seizure | Anti-seizure | Anti-seizure | Anti-seizure | |
| Anti-depressant | Anti-depressant | Anti-depressant | Anti-depressant | Anti-depressant | Anti-depressant | |
| Calcium channel blockers and other anti-hypertensives | Calcium channel blockers and other anti-hypertensives | Calcium channel blockers and other anti-hypertensives | Calcium channel blockers and other anti-hypertensives | Calcium channel blockers and other anti-hypertensives | Calcium channel blockers and other anti-hypertensives | |
| Toxin injections | Toxin injections | Toxin injections | Toxin injections | Toxin injections | - | |
| Gepantf | Gepantf | Gepantf | - | Gepantf | Gepantf | |
| - | - | - | Other oral preventive | - | - | |
AHS, American Headache Society; CGRP, calcitonin gene–related peptide; ENT, ear, nose, and throat specialist; GP, general practitioner; HCP, health care professional; IM, internal medicine; MHD, monthly headache day; NP, nurse practitioner; NSAID, nonsteroidal anti-inflammatory drug; Ob-Gyn, obstetrician-gynecologist; PA, physician assistant; PM&R, physical medicine and rehabilitation physician; Rx, prescription; UK, United Kingdom; US, United States
aHealth care professionals varied by country based on input from headache experts in each respective country. bOnly a few patients received care from an ophthalmologist, orthopedic doctor, or PM&R. cAppropriate treatment as per AHS guidance. dRespondents were excluded if the only acute treatment received was an opioid. eDitans were considered appropriate acute treatment in the countries in which they were available at the time of the survey. fGepants were considered appropriate treatments in the countries in which they were available at the time of the survey. gIncludes acetaminophen + caffeine. hIncludes Rx aspirin and Rx acetaminophen. iPer the AHS Consensus Statement, preventive medication for migraine should be offered to people with ≥ 6 MHDs regardless of disability, those with ≥ 4 MHDs with at least mild disability, and those with ≥ 3 MHDs with at least severe disability