1. Workshop + next steps, CEEAM Istanbul September 21, 2007 Migraine in CEE countries : Summary + conclusions

2. Population of ca. 175 M (w/o CIS) Different medical systems, economic level General price sensitivity of patients Country description

3. Health care system Triptans – the most effective treatment – are usually at least partly reimbursed Often, reimbursement only with NEU approval Q: Is reimbursement a real barrier for adequate treatment? Is triptan status to be changed ?

4. Current issues in migraine management Diagnostic: –primarily at NEU –Somewhere mandatory NEU exam. before triptans –Easy to use dg. tool ? Therapy: –Primary care vs. specialist –guidelines- existing/implemented ? Barriers –Awareness: patient, GP, NEU –Headache vs. Migraine ? (GP, patients) –Triptan price –Availability: Rx vs. OTC

5. Headache Society, Centers and Specialists: role in migraine management Headache society: Established: HU, LT,CZ, BG, LV, TR, PL None or defunct: EE, RO, SK, Influence on treatment: –Guidelines –Reimbursement –NETWORK ? („map of migraine specialists) Education („Who can train who ?“) –Own members / specialists –GPs –Patients Coordination of international cooperation, EHF… Awareness creation: whose awareness ?

6. The role of GPs in migraine management Interest ? Capacity ? Education –Skill + knowledge –Tools (test) Support by guidelines

7. Common issues Awareness –Patients –GPs Education Guidelines System: –GP role,referral systém –Status of triptans (NEU only; reimbursement) –Price of treatment

8. Migraine awareness : now 1.Specialists: May underestimate QoL issue are they contacted by the patients ? 2.Patients: Mostly go for self-medication (symptomatic) Do not know about „curability“ of migraine 3.GPs: are not addressed – „no patients“ no motivation to solve accidental complaints May lack knowledge fo advice /act

9. The migraine awareness: future 1.Patients: Knowledge of disease, of its curability Pathways established (where to ask) 2.GPs: –primary contact, –screening role ? –treatment incl. Triptans ? 3.Specialists: referral for diff. Dg if necessary Refractory cases + profylaxis

10. Do we (CEEAM) want to help? Can we help ? Structure Country champions Communication platform Meeting schedule Projects: –Discuss now !

11. CEEAM projects (possible) : 1.Guidelines – transfer + sharing 2.Exchange of contacts, sharing ideas online 3.Education: local vs. International events 1.for neurologists 2.For primary care 4.PR: Days of migraine 5.Epidemiology of migraine 6.pharmacoeconomy

12. International contact point CEEAM Simple tool: www.ceeam.info Education platform: training scheme Transfer of guidelines Epidemiologic data PR – days against migraine

15. CEEAM projects next steps 1.Guidelines – transfer + sharing: Existing guidelisens (CZ, PL, TR) will be translated and published on CEEAM web for reference 2.Exchange of contacts, sharing ideas online: webpage active by mid- October 2007, passwords available to participants 3.Education: local vs. International events 1.for neurologists: best way = support( stipends) for exisiting EHF and IHS events – e.g. Summer schools 2.For primary care: done locally, CEEAM may build an international curriculum for such course. Priority for 2008 4.PR: Days of migraine: to be done locally, Zentiva committmen to support 5.Epidemiology of migraine: Zentiva Industry sponsored NCT to be published 2008 in Krakow (WONCA) 6.Pharmacoeconomy: considered very important but postponed until next year