The pharmacological treatment of migraine in Brazil

Migraine is a chronic, disabling, and recurrent illness. Despite its burden, preventive medications are often underused, while acute strategies are frequently used injudiciously. Patients may benefit from comprehensive approaches with general informative orientation and formal medication strategies. In developing countries like Brazil, the access to comprehensive tertiary headache centers or updated specialists is somewhat limited, as are the resources available out of some private specialty care clinics. In addition, centers from the public system may not deliver effective care. The aim of this review is to perform a general description of the pharmacological treatments of migraine in tertiary headache centers of Brazil.

The data of 4 public and 6 private tertiary centers under the care of 16 neurologists involved with headache assistance in different cities of Brazil were gathered. Answers to questions directed to headache specialists, and analyzing data from previous care of patients was used to estimate a description of the general pharmacological approach used in Brazilian centers. The therapeutic options adopted by general practitioners were not considered as those from other medical specialties and holistic medicine, which also treat migraine on a common basis.

Estimated data of nearly 4800 patients from 16 neurologists acting in headache clinics from 2005 to 2013 were collected. Headache approach by specialists in Brazil is basically divided into 2 groups. The public services, which assist nonpaying patients, deliver traditional and noncomprehensive approaches as well as prescribe mostly monotherapy. Roughly 30% of their patients do not receive preventive treatments that are generally tricyclic antidepressants or β-blockers. Private centers, which are usually where paying people attend, as well as a few public centers of excellence, use multidisciplinary approaches and combination of drugs, despite the usual allegation of scarce evidence. Nearly 90% of the patients from these centers receive the prescription of preventive treatments, which are generally tricyclic antidepressants and/or neuromodulators and/or β-blockers.

There is no consensus on whether patients turning to private tertiary centers are different from those seen in public nonpaying services. However, since it is directly related to economic status and public services may render free specific medications as well as official dispensation of work, it may be argued that patients have less headache impact, and suboptimal care is delivered in these instances. As for the studied private centers as well as for the few public excellence centers, care provided is usually varied, includes a combination of drugs, and prevention is commonly used.