1. The Migraine management in Turkey Mustafa Ertaş Department of Neurology Istanbul Faculty of Medicine

2. 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

3. Health care system Regulations: Strict Reimbursement: State Private Health Insurance Companies Reference for pricing: Lowest price among European Union countries

4. 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

5. 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 women 10.9% in men

6. 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

7. 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

8. 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)

9. 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)

10. 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)

11. 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

12. 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%

13. 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