György Bozsik MDSemmelweis UniversityFaculty of MedicineDepartment of NeurologyBudapest

Migraine management in Hungary

21.09.2007Istanbul, Turkey

Hungary

Inhabitants: 10 million

Capital: Budapest (2 million inhabitants)

GDP per capita: 8815 euro (2005)

Healthcare expenditure as the percentage of GDP (2004)

-Total expenditure on health per capita: 856 USD - Pharmaceutical expenditure on health, % of total expenditure on health: 26 %

- Practising physicians density per 1000 population 4

- active beds density per 1000 population 6

- chronic beds density per 1000 population 2

- MRI units per million population 1,8

- CT scanners per million population 5,7

Organisation for Economic Co-operation and Development (OECD), 2000

Hungary

Austria Czech Rep. Poland Slovakia Hungary Russia

Expected lifetime at birth(men, 2004)

Total health expenditure by financing agent, 2004

Migraine - diagnosis

0

10

20

30

40

50

60

migraine

diagnosed non-diagnosed

Spierings ELH, 2002

05

101520253035404550

Adelman JU et al,2000

Patient visits the outpatient service

Headache historyDanger signals ? YES Refer to specialist,

Determine secondary headache NO disorder ( consultation,physical, examination, neuroimaging etc.)

Physical examinationabnormality ? YES

NO

Specific disease ?Unusual, rare disease ? YES Reconsider the diagnosis of

symptomatic/secondaryNO headache disorder

Treatment of primary headache disorder (Silberstein SD, Lipton RB, Goadsby P, 1998)

• Migraine management is based on the diagnostic criteria of the International Headache Society (2nd edition, 2004)

• Diagnostic algorhythm for headaches

Acute treatment of migraine with triptans in Hungary

-prescripton is required-25% of price is reimbursed, but only if prescribed by a neurologist-NEW: 100% reimbursed in exceptional cases (low income patients, limited quantity)-available triptans:

• Barriers: -price -self medication with OTC products -low awareness

triptan full price (euro)

sumatriptan (6x100mg) 49

sumatriptan gen. (6x100mg) 24

eletriptan (6x40mg) 28

zolmitriptan (3x2,5mg) 19

Headache managementin Hungary

• First headache outpatient service at Semmelweis Dept. of Neurology in 1976

• Regular postgraduate seminars since 1977• Headache section of the Society of Neurologists and Psychiatrists of Hungary in 1990• Annual conferences since 1994• Cephalalgia Hungarica since 1994• Headache centres (22) since 1995 • Hungarian Headache Society (members > 200) since 1996• Treatment protocol of primary headache disorders 2004• Internet:www.fejfajas-tarsasag.hu

Population of territories covered by headache outpatient services

average: 228 750 ( range: 50 000-450 000)altogether: 3 360 000

050000100000150000200000250000300000350000400000450000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

population

Ways of improvement

• Key activities:– Increase the awareness of patients– Incourage the establishing of a patient

association– Increase graduate / postgraduate training for

doctors• International cooperation:

– Increase cooperation between national headache societies

– Initiate an East-European study about migraine and its management?