Migraine Thesis DefenseMigraine Thesis Defense.pptxpptx

Migraine Thesis Defense.pptx

1. Research Thesis Defense P re se nt er : Alembante Mulye , MD, Fin al Y ear Neurolog y Resident Date- March-7 2025

2. The utilization of pharmacologic preventive therapy among migraine patients and their outcome at Tikur Anbesa Specialized Hospital, Yekatit 12 Hospital Medical college, and Zewditu Memorial Hospital, in Addis Ababa, Ethiopia. Advisors :- Dr Yared Mamushet ( Internist,consultant neurologist, stroke sub-specialist) Dr Michael Tesfaye ( Consultant Neurologist ) Dr Selam Kifelew ( Consultant Neurologist )

3. Outline Introduction Objectives Methodology Results Discussion Conclusion Limitations Recommendations Acknowledgment

4. Introduction Headache disorders rank third globally in causing disablity, with migraine and medication overuse headache being the most common In Ethiopia, migraine accounts for 17.7% of headache disorders Women are disproportionately affected more than men Although at least 25% of migraine patients require prophylactic treatment, only 3-13% actually received it.

5. Goals of preventive therapy is to reduce severity, frequency, duration of migraine attacks, improve quality of life and response to acute treatment. Indications to start prophylaxis include at least 4 headache days per month, severe or intolerable atacks despite acute therapy, contraindications to acute treatments Available options are beta-blockers, anti-convulsants, tricyclic antidepressants and the newer CGRP-targeting therapies

6. Statement of the problem Career & Income Impact: In Austria, one-third of migraine patients faced career challenges, and 21.5% reported income loss. Underdiagnosis: Only 13% of migraine sufferers in developing countries receive a proper diagnosis. Limited Prophylaxis: In Russia, less than 1% receive preventive treatment, though 17% were candidates. Treatment Gaps: An Italian study revealed low use of prophylaxis, leaving many patients untreated

7. Significance of the study Migraine Impact: A common disorder that affects quality of life. Limited Data: In Ethiopia, little is known about migraine prophylaxis effectiveness and patient access to preventive therapy. Clinical Relevance: Identifies gaps to help clinicians provide better care and improve patient outcomes. Future Reference: Serves as a foundation for future research and comparisons in the field.

8. Objectives To assess the utilization of pharmacologic prophylaxis among migraine patients in adults visiting Neurology OPD at TASH, Y12HMC, and ZMH, Addis Ababa, Ethiopia. To evaluate the outcome of migraine patients on pharmacologic prophylaxis visiting the Neurology clinic at these hospitals in Addis Ababa, Ethiopia

9. Methodology Study Design Multicenter, retrospective, cross-sectional study. Conducted at Tikur Anbessa Specialized Hospital, Yekatit 12 Hospital Medical College, and Zewditu Memorial Hospital in Addis Ababa. Data collected retrospectively from patient records and follow-up visits (July 2024 – January 2025).

10. Sample Size Determination Assume 50% prevalence to maximize sample size - Cochran’s Formula for sample size calculation: n = (Z² * P(1-P)) / d² Where: Z = 1.96 (95% Confidence Level) P = 0.5 (Assumed Prevalence) d = 0.05 (Margin of Error) n = (1.96)² × 0.5(1-0.5) / (0.05)² = 384

11. Adjustment for Small Population: Total visits over 6 months TASH: 15 patients/month ZMH: 4 patients/month Y12HMC: 5 patients/month Total = 144 patients Adjusted sample size using finite population correction: n = 384 / [1 + (384 / 144)] = 104.74 Considering 10% non-response rate: 115 patients Total patients participated in the Study = 90 patients

12. Cont’d.. Participants Recruited from neurology OPDs by the principal investigator. Inclusion criteria: Migraine patients aged ≥18 years on regular follow-up. Exclusion criteria: Severe psychiatric disorders (e.g., schizophrenia, bipolar disorder) to minimize confounding.

13. Cont’d Study variables Dependent variable - utilization of prophylaxis and outcomes of preventive therapy Independent Variable - Demographic factors, comorbidity,duration of prophylaxis, severity of headache, adherence and drug side effects

14. Cont’d Data Collection Frequency of attacks, severity, duration, ER visits Structured questionnaires (KoboToolbox platform). Validated migraine assessment tools adapted to local context.

15. cont’d Data Analysis SPSS v-25.0 software Descriptive statistics: Mean, SDs, frequencies, percentages Data Cleaning: Performed exclusively by the investigator Data Presentation: Descriptive summaries presented in tables and figures Significance Level: Variables with P < 0.05 considered statistically significant

16. Data quality control The questionnaire was reviewed for completeness and clarity before data collection A pre-test was conducted on 5% of the sample in a similar setting to identify any issues with the instrument Filled questionnaires were regularly checked for completeness and consistency.

17. Cont’d Ethical Consideration Ethical approval: Addis Ababa Health Bureau & TASH Research and Publications Committee (RPC). Informed consent: Obtained from all participants. Confidentiality:Data anonymized & securely stored. Restricted access to research team. Voluntary participation: Right to withdraw without affecting medical care.

18. Results

19. Socio-demographic and economic characteristics of study participants

20. Clinical-related characteristics of study participants

21. Migraine prophylactic preventive therapy-related characteristics 80% received prophylactic medications beyond common pain relievers Reasons for Starting Prophylaxis Frequent attacks (29.1%) Severity & Neurologist recommendation(each-20.8%) Both severity & frequency: 13.8%

22. Common Medications Used by Participants

23. Treatment Outcomes & Effectiveness 66.7%-Improved in frequency, severity, and duration 11.1%-Reduced headache frequency only 8.3%-Noted less severe headaches

24. Correlation Among HIT-6, MSQ-RR, and MIDAS Scores HIT-6 & MIDAS (r = 0.457) Moderate positive correlation → Higher headache impact leads to greater migraine-related disability. HIT-6 & MSQ-RR (r = -0.669) Strong negative correlation → Increased headache impact results in greater role restrictions and lower quality of life. MIDAS & MSQ-RR (r = -0.551) Moderate negative correlation → Higher migraine-related disability limits daily activities and reduces quality of life.

25. MIDAS-Score MSQ-RR HIT-6 MIDAS-Score 1 MSQ-RR -.551 ** 1 HIT-6 .457 ** -.669 ** 1

26. Quality of Life (QoL) Scores Variable Domains Mean Standard deviation Migraine-specific quality of life Role function restrictive Role function preventive Emotional function 60.9 60.3 62.4 17.9 19.1 15.6

27. Frequency distribution according MIDAS score summary

28. Frequency distribution according to HIT score summary

29. Discussion PANORAMA Survey {Germany} => 41.6% prophylaxis utilization vs. 80% in this study Fewer specialized centers in our study, higher discontinuation in PANORAMA AMPP Study {USA} => 3-13% received prophylaxis vs. 80% in this study Difference attributed to study populations (specialized hospitals vs. general population)

30. Prescribing Patterns First-line medications: Amitriptyline, Propranolol, Sodium valproate Consistent with international recommendations for migraine prophylaxis No prescriptions for gepants or topiramate

31. Emergency Visits 77.78% didn’t reqire emergency care for headache after Prophylaxis 22.22% still required emergency care 62.5% reported faster recovery with acute treatment

32. Adherence (Morisky Medication Adherence Scale)

33. Conclusion This study highlights the high utilization of pharmacologic preventive therapy ( 80%) among migraine patients in three specialized hospital centers in Addis Ababa, compared to lower rates (3-13%) and (41.6%) in international studies. Preventive therapy was effective in reducing migraine frequency, duration, and severty, although some patients ( 15.2%) found it ineffective.

34. Limitations Sample Representation Lack of Baseline Data Limited Treatment Scope => No patients received gepants, restricting conclusions on newer migraine therapies Recall bias

35. Recommendations To Include HIT-6, MIDAS, and MSQ before initiating therapy for better outcome assessment. To enhance awareness of health professionals by ensuring appropriate patient selection for preventive therapy To Assess feasiblity of introducing gepants for improved efficacy and tolerability Expand research to non-specialized centers

36. Acknowledgement I would like to express my gratitude to the Department of Neurology in AAU for granting me the opportunity to conduct research on a topic that I am truly passionate about. I am grateful to my advisors, Dr. Yared M, Dr. Michael T, and Dr. Selam K, for their guidance, and generous support throughout this journey. Their expertise and encouragement have been a cornerstone of my research.

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39. Thank You

40. Questions?