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