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György Bozsik MD Semmelweis University Faculty of Medicine Department of Neurology Budapest

György Bozsik MD Semmelweis University Faculty of Medicine Department of Neurology Budapest. 21.09.2007 Istanbul, Turkey. Migraine management in Hungary. Hungary. Inhabitants: 10 million Capital: Budapest (2 million inhabitants). GDP

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György Bozsik MD Semmelweis University Faculty of Medicine Department of Neurology Budapest

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  1. György Bozsik MDSemmelweis UniversityFaculty of MedicineDepartment of NeurologyBudapest 21.09.2007 Istanbul, Turkey Migraine management in Hungary

  2. Hungary Inhabitants: 10 million Capital: Budapest (2 million inhabitants) GDP per capita: 8815 euro (2005)

  3. Healthcare expenditure as the percentage of GDP (2004)

  4. Total expenditure on health per capita: 856 USD - Pharmaceutical expenditure on health, % of total expenditure on health: 26 %- Practising physicians density per 1000 population 4- active beds density per 1000 population 6- chronic beds density per 1000 population 2- MRI units per million population 1,8- CT scanners per million population 5,7 Hungary Organisation for Economic Co-operation and Development (OECD), 2000

  5. Expected lifetime at birth(men, 2004) Austria Czech Rep. Poland Slovakia Hungary Russia

  6. Total health expenditure by financing agent, 2004

  7. Migraine - diagnosis Spierings ELH, 2002 Adelman JU et al,2000

  8. Patient visits the outpatient service Headache history Danger signals ? YES Refer to specialist, Determine secondary headache NO disorder ( consultation,physical, examination, neuroimaging etc.) Physical examination abnormality ? YES NO Specific disease ? Unusual, rare disease ? YES Reconsider the diagnosis of symptomatic/secondary NO headache disorder Treatment of primary headache disorder (Silberstein SD, Lipton RB, Goadsby P, 1998) • Migraine management is based on the diagnostic criteria of the International Headache Society (2nd edition, 2004) • Diagnostic algorhythm for headaches

  9. Acute treatment of migraine with triptans in Hungary -prescripton is required -25% of price is reimbursed, but only if prescribed by a neurologist -NEW: 100% reimbursed in exceptional cases (low income patients, limited quantity) -available triptans: • Barriers: -price -self medication with OTC products -low awareness

  10. Headache managementin Hungary • First headache outpatient service at Semmelweis Dept. of Neurology in 1976 • Regular postgraduate seminars since 1977 • Headache section of the Society of Neurologists and Psychiatrists of Hungary in 1990 • Annual conferences since 1994 • Cephalalgia Hungarica since 1994 • Headache centres (22) since 1995 • Hungarian Headache Society (members > 200) since 1996 • Treatment protocol of primary headache disorders 2004 • Internet:www.fejfajas-tarsasag.hu

  11. Population of territories covered by headache outpatient servicesaverage: 228 750 ( range: 50 000-450 000)altogether: 3 360 000

  12. Ways of improvement • Key activities: • Increase the awareness of patients • Incourage the establishing of a patient association • Increase graduate / postgraduate training for doctors • International cooperation: • Increase cooperation between national headache societies • Initiate an East-European study about migraine and its management?

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