[Therapeutic strategies used by neurologists and primary care physicians in the symptomatic treatment of migraine. Findings from Strategia-I and Strategia-II opinion studies].
BACKGROUND
Few studies have been carried out on the subject of stratification of medical care for migraines, and even fewer have been conducted with the aim of determining the attitudes adopted by physicians towards their patients when dealing with this issue. Strategia-I and II studies were designed for this purpose.


METHODS
The sample consisted of 162 neurologists and 3,168 Primary Care physicians (PCP). Participants in the studies filled out an opinion survey that was produced ad hoc and included the different possible strategies, namely a) Stepped care between attacks (the patient takes medication during several attacks and, if it is not effective, it is replaced by another in successive attacks); b) Stepped care within attacks (the patient treats his or her seizures with medication and, if it does not work, another is used as rescue medication); and c) Stratified care (the physician classifies the patient according to the degree of disability produced by the migraine and recommends the most appropriate drug at the start).


RESULTS
Most participants in the study (90.7% of neurologists, 85.2% of PCP) reported using a single strategy. Stratified care was found to be the preferred choice by both collectives (67.6% of neurologists, 43.8% of PCP; p < 0.0001). Only 16% of the respondents admitted using some disability scale. Nonsteroidal antiinflammatory drugs are the medication chosen if disability is mild-moderate, while triptans are preferred if it is moderate-severe (92.9% of neurologists, 78.8% of PCP; p < 0.001).


CONCLUSIONS
The strategy based on stratified care is the most widely used in visits to Neurology and Primary Care in Spain, although there are significant differences between the two collectives. Triptans are perceived as being the ideal medication in situations involving moderate-severe disability.
Mateos
V
V
Servicio de Neurología, Hospital Central de Asturias, 33006 Oviedo, España. vmateosm@telefonica.net
Galván
J
J
Heras
J
J
D002985:Clinical Protocols; D006801:Humans; D008881:Migraine Disorders / Q000628:therapy*; D009462:Neurology; D011320:Primary Health Care