Migraine prevalence and treatment patterns: the global Migraine and Zolmitriptan Evaluation survey.

OBJECTIVE: The objectives of the Migraine And Zolmitriptan Evaluation (MAZE) survey were to assess the prevalence of migraine in the general population across 5 different countries, to understand migraineurs' experience of migraine and its management on a global level, and to assess patient perceptions and preferences of current and future treatment formulations.

METHODS: A two-phase, international survey was performed in France, Germany, Italy, the UK, and the USA, and involved a total of 5553 adults. In Phase I, >/=1000 adults from the general population in each country were interviewed by telephone using a routine consumer survey. The proportion of subjects meeting International Headache Society (IHS) criteria for migraine was assessed using an adapted Kiel headache questionnaire, whereas the impact of migraine on daily life was assessed using the Migraine Disability Assessment Scale (MIDAS) questionnaire. In Phase II, >/=100 clinically diagnosed migraineurs per country were recruited through their general practitioners and migraine clinics. Semi-structured interviews based on written questionnaires assessed the impact of, and attitudes toward, migraine and its treatments. Respondents also completed the MIDAS questionnaire. Patients also sampled a demonstrator version of the new orange-flavored orally disintegrating tablet of zolmitriptan.

RESULTS: Phase I: An estimated 5% to 12% of the population in the different countries were classified as suffering from migraine, with most attacks categorized as fairly severe to very severe. Between 23% and 42% of migraineurs reported>24 attacks in the previous 12 months. Approximately one-half of all migraineurs did not seek medical advice. Of those who did consult a physician, only 3% to 19% were prescribed triptans. In all countries, the most commonly used current treatment was simple analgesics (22% to 54%). Phase II: Current migraine therapy was consistently effective in only 19% to 31% of patients, and only 21% to 50% of patients were satisfied with their current treatment. Many sufferers supplemented their prescription therapy with alternative management strategies, including herbal and homeopathic remedies, stress management, relaxation therapy, avoidance of trigger factors, and bed rest. Patients indicated that the most important attributes of migraine therapies are high efficacy and rapid pain relief. When asked to identify delivery options that they would like to see more of in the future, most patients (73%) specified "a dissolve-in-the-mouth tablet." Ninety percent of patients who sampled the demonstrator version of the zolmitriptan orally disintegrating tablet considered it to be "very easy" to use, and 99% stated it was suitable for use "anytime/anywhere."

CONCLUSIONS: In the general population samples we surveyed, there was a 5% to 12% prevalence of migraine across 5 different countries. As reported from previous epidemiologic studies, we found that many migraineurs still do not consult a physician. Despite high levels of disability, as assessed by MIDAS scores and evidenced by the need for bed rest during attacks, many migraineurs continue to treat their headaches with simple analgesics, which, if ineffective, leads to dissatisfaction with treatment. Patients desire a medication with high efficacy and a rapid onset of action, and an orally disintegrating tablet such as that used for the new zolmitriptan formulation, is a favored formulation and route of administration.