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Published on: June 2, 2014
Knowledge, Attitude, and Practices of General Neurologists and Headache Experts Toward Migraine Treatment: A
Sanjith Aaron1, Ashish Bondia2, Ishan Patel2
1Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India.
Background And Objectives:
Migraine, a disabling neurological disorder, poses a significant global burden, especially among women of reproductive age. In India, inconsistent diagnoses and the underutilization of evidence-based therapies present substantial challenges. This study evaluated the knowledge, attitudes, and practices of general neurologists and headache experts in India regarding migraine diagnosis and treatment, identifying barriers and opportunities for improvement in clinical care.
Methods:
A cross-sectional online survey was conducted among 137 clinicians in India (125 general neurologists and 12 headache experts). The questionnaire assessed diagnostic approaches, preferences for pharmacological and non-pharmacological treatments, utilization of guidelines, and readiness to adopt novel therapies. Data were analyzed using descriptive statistics.
Results:
Headache experts reported a higher patient burden, with 9 (75.00%) seeing 25 or more headache patients per week, compared to 39 (31.2%) general neurologists. Migraines comprised over 50% of cases for 7 (58.33%) of the experts. The use of International Classification of Headache Disorders (3 rd edition) criteria was markedly higher among headache experts (91.67% vs. 38.71%), as was the Migraine Disability Assessment (66.67% vs. 24.20%). Nonsteroidal anti-inflammatory drugs and triptans were the most commonly prescribed therapies. Although triptans provided only moderate relief for most patients, newer agents, such as ditans, were rarely used (0-20%). Nonpharmacological interventions were widely adopted, with approximately 90% usage in both groups. Barriers included limited diagnostic standardization, therapeutic inertia, low familiarity with newer agents, and operational challenges such as time constraints.
Conclusions:
Both general neurologists and headache experts acknowledge the burden of migraine and practice holistic management. However, gaps remain in standardized diagnosis, optimal triptan use, and the adoption of novel therapies. Enhancing clinician education, promoting validated diagnostic tools, developing expert consensus, and increasing community awareness are crucial to optimizing outcomes and reducing therapeutic inertia.
