Table 3.

Studies reporting clinical management of migraine

Citation	Country/region	Study design Study dates	Migraine criteria	Population (n)	Main findings for participants with migraine
Wang, 2011 and Li, 2012 [22, 28]	China / Mainland	Cross-sectional other: neurological outpatient department 2010	ICHD-II	401 patients with migraine	Practice pattern over the past 1 y: • 68.6% of patients had consulted a physician, 13.5% were diagnosed with migraine, 37.2% had not received any diagnosis Treatment over the past 3 mo: • 43.1% had not used analgesics for migraine, 11.7% were using analgesics ≥3 days/wk., none had used triptans, 2.7% had used preventive drugs
Liu, 2013 [24]	China / Mainland	Population-based 2009	ICHD-II	452 adults with migraine	Practice pattern over the past 1 y: • 52.9% of adults had consulted a physician for headache • 52.7% of adults who had a consultation for headache were undiagnosed • 13.8% were diagnosed with migraine, the remaining were diagnosed with other headache disorders Significant predictors of consultation for migraine were mild, moderate, or severe disability (HALT index) vs minimal HALT (0–5 days lost/3 mo): • Mild 6–10 days lost: adjusted OR 3.4 (95% CI, 1.6–7.4) • Moderate 11–20 days lost: adjusted OR 2.5 (95% CI, 1.2–5.4) • Severe > 20 days lost: adjusted OR 3.9 (95% CI, 1.9–8.1)
Lu, 2001 [35]	China / Taiwan	Population-based 1997–1998	> 15 headache days/mo for > 1 mo; > 4-h duration	108 adults with chronic daily headache	Practice pattern and treatment over the past 1 y: • 57% had consulted a physician for their headache • 41% consulted their family physician, 28% neurologist • 5% were treated with preventive drugs
Wang, 2000; Wang, 2001 [43, 44]	China / Taiwan	Population-based 1997–1998	IHS migraine and modified migraine (IHS + attacks of 2- to 4-h duration)	328 adults with migraine	Practice pattern over the past 1 y: • 54% had consulted a physician for the headache • 18% of these had been diagnosed with migraine by their physician Treating physicians • 29% general practitioners • 17% internists, 14% ENT specialists, 12% neurologists • 4.9% gynecologists, 4.6% ophthalmologists, 1.2% allergists, 2.7% other
Lu, 2006 [37]	China / Taiwan	Cross-sectional other: neurologists in Taiwan NR	NA	123 neurologists in Taiwan	31.7% of patients seen were outpatients with migraine Attitudes: • 88.5% reported headache to be an important part of their practice • 40.2% thought headache patients to be time-consuming • 86.9% reported patient satisfaction as an important consideration for treatment • 89.9% thought behavioral therapy to be an important part of treatment Treatment: • 69.9% agreed that preventive medication was indicated for ≥2 migraine attacks/wk., but 12.2% prescribed preventives for patients with ≥14 headaches/mo • Most commonly prescribed drugs were beta-blockers (96.7%), flunarizine (87.0%), tricyclic antidepressants (80.5%), and valproic acid (54.5%) • 32.5% had never prescribed triptans, mostly because of cost (35%)
Wang, 2008 [39]	China / Taiwan	Cross-sectional other: neurological clinics 2005	ICHD-II (MOA, MWA, probable)	755 patients with headache attending a neurology clinic for the first time	60% were diagnosed by neurologists with migraine 48% had MWA or MOA (ICHD-II) 71% had any migraine type (ICHD-II) of these, 23% were not diagnosed by neurologists as having migraine 57.4% diagnosed with any migraine (ICHD-II) had never been diagnosed with migraine previously
Wang, 2013 [46]	China / Taiwan	Cross-sectional other: headache clinics 2011	Neurologist diagnosis / ICHD-II	331 adults with migraine at neurology clinics	Over the past 3 mo for chronic migraine vs episodic migraine Health care professional evaluation of headache: 85.6% vs 81.7% • General practitioner: 34.3% vs 24.6% • Neurologist/specialist: 79.0% vs 80.6% • Emergency room visits: 21.0% vs 5.5% • Hospital admission: 4.8% vs 0% • Preventive medication: 48.5% vs 31.7%
Sakai, 1997 [51]	Japan	Population-based NR	IHS migraine and modified migraine (IHS + attacks of 2- to 4-h duration)	338 adults with IHS-defined or other defined migraine	69.4% had never consulted a physician for headache 11.6% were aware their headache was migraine 56.8% were taking OTC drugs 5.4% were taking prescription drugs 18.6% were taking OTC and prescription drugs 19.2% were not taking any medication
Takeshima, 2004 [53]	Japan	Population-based 1999	IHS	Adults 41 with MWA 301 with MOA	MWA vs MOA Most never consulted a physician for migraine 61.0% vs 71.8% Few continuously consulted a physician for migraine 7.3% vs 5.3% Main reasons for not consulting or not continuing to consult a physician: • Headache not severe enough 35.7% vs 29.3%; 38.5% vs 30.4% • Will improve spontaneously after standing 57.1% vs 56.9%; 30.8% vs 27.5% • OTC medication effective 21.4% vs 53.7%; 23.1% vs 30.4%
Kotani, 2004 [50]	Japan	Cross-sectional: other NR	IHS	35 patients with migraine at a general health clinic	Main reasons for not previously seeking medical attention: • 28.6% can endure symptoms without medication • 28.6% OTC medication is effective • 28.6% could not miss work • 25.7% could sleep and wake pain-free
Suzuki, 2014 [52]	Japan	Community-based 2007–2008	ICHD-II	704 employees in Tokyo	1.3% regularly visited their physicians 59.4% had never consulted with a physician about their headaches The most common reasons (n = 173) for stopping visits to a physician were: told their condition was not fatal (45.1%), unable to get adequate advice from their physician (20.2%), and no time (14.5%)
Roh, 1998 [59]	South Korea	Population-based 1996	IHS	272 adults with migraine	64.3% used medication for their migraine 92.8% used OTC medication 24.4% had consulted a physician for headache
Children/adolescents
Lu, 2000 [36]	China/ Taiwan	Population-based 1998–1999	IHS	Children 13–15 y, 277	72.1% of children used painkillers for their headache 11.5% used painkillers ≥1 d/wk
Goto, 2017 [48]	Japan	Population-based 2012	ICHD-IIIβ (unilateral aura not included)	Children 6–12 y, 48 12–15 y, 37	Elementary school and junior high school students who reported disability due to migraine: • 44.9% and 47.9% had not had a medical consultation for their migraine • 30.6% and 8.3% had not received prescription medication for their migraine

CI confidence interval; F female; HALT Headache-Attributed Lost Time Index; ICHD-I/II/IIIβ International Classification of Headache Disorders; ICD-9-CM International Classification of Diseases, 9th revision, Clinical Modification; IHS International Headache Society; NA not applicable; NR not reported; MOA migraine without aura; MWA migraine with aura; OTC over-the-counter; OR odds ratio; SD standard deviation