the migraine management in turkey mustafa ertaş department of neurology istanbul faculty of...
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The Migraine management in Turkey
Mustafa ErtaşDepartment of Neurology
Istanbul Faculty of Medicine
• Population is 72.1 million in 2005• Life expentancy is 71.3 years• Urbanized population (2005) is 67%• Population: 10 million for Istanbul
4 million for Ankara (capital city)• GNI per capita is 4.750 US$• HC (Health Care) expenditure is 3-5% of GNP
Country description
Health care system
• Regulations: Strict• Reimbursement:
State
Private Health Insurance Companies
• Reference for pricing:
Lowest price among European Union countries
Health care system
• Reimbursement for triptans: (80% of price)
– Oral forms if prescribed by neurologist without report
– Any physician may prescribe if the patient has report
– Subcutan form is subjected to report
– All forms up to 6 doses per month
Current situation in migraine management• Prevalence:
Nationwide home based Migraine prevalence study (1998)in Turkey:
16.4% at 15-55 age range
22.8% in women10.9% in men
Current situation in migraine management• Diagnosis: By GPs and Neurologists
– ID Migraine test (3-item test)
• Therapy: Mostly GPs treat migraine (w/o triptans)• Barriers:
– there is no headache treatment guideline– self medication (no prescription needed)– low awareness of migraine in patients and physicians– high price of triptans compared to analgesics
PRICE: 1 tb sumatriptan 50 mg = 117 tb aspirin
The role of Headache Society, Centers and Specialists in migraine management
Turkish Neurological Society Headache Study Group
includes headache specialists and
headache-interested physicians, and
represents Turkey in European Headace Federation
The role of Headache Society, Centers and Specialists in migraine management
Turkish Neurological Society Headache Study Group
• Treatment
preparing headache treatment guideline (about to finish)
The role of Headache Society, Centers and Specialists in migraine management
Turkish Neurological Society Headache Study Group
• Education– organizing Annual Headache School for 6 years
for neurologists and GPs (5 days, ~ 250 people)– organizing local meetings for neurologists and
GPs in different cities (~10 meetings a year)
The role of Headache Society, Centers and Specialists in migraine management
Turkish Neurological Society Headache Study Group
• Coordination
coordinating national headache multicenter studies (drug trials, clinical studies, prevalence studies)
The role of GPs in migraine management
• Part in migraine treatment– Mostly GPs treat migraine patients– cannot start triptans but repeat prescription
• Education– Lectures on headache at Medical Faculties (6 years)
are 1-2 hours– Postgraduate headache education by Turkish
Neurological Society and meetings supported by industry
The migraine awareness among population
• Specialist: improving• GPs: modestly improving by postgraduate educat.• Patients: improving by media• Current days – future- ideal status
Medication overuse headache: ~2%
The POSSIBILITIES how to IMPROVE it!
• Key activities: Meetings with GPs and specialists
Headache courses for GPs and specialists
Media interviews
• International cooperation:Increasing the local center numbers in multinational trials