The disease burden of migraine patients receiving prophylactic treatments in Korea: a population-based claims database analysis

The burden of migraine and predictions in the Asia-Pacific region, 1990-2021: a comparative analysis of China, South Korea, Japan, and Australia

BACKGROUND

Migraine is a leading cause of disability worldwide, significantly impacting quality of life and healthcare systems. Despite its high prevalence and burden, migraine remains underprioritized in global health policies. This study examines the epidemiological trends of migraine in Australia, China, Japan, and South Korea from 1990 to 2021, highlighting regional disparities and forecasting future burdens.

METHODS

This study utilized data from the Global Burden of Disease (GBD) 2021 to analyze incidence, prevalence, and years lived with disability (YLDs) of migraine. Age-standardized rates (ASRs) were calculated to enable fair cross-country comparisons. Joinpoint regression analysis was applied to assess temporal trends, while Bayesian age-period-cohort (BAPC) modeling was used to project future trends until 2050. Additionally, decomposition analysis was conducted to differentiate the effects of population aging, growth, and epidemiological changes.

RESULTS

In 2021, China had the highest migraine burden, with 13.05 million new cases and 184.75 million prevalent cases, followed by Australia, Japan, and South Korea. Incidence rates peaked in adolescence (10-14 years), while prevalence and disability were highest in middle-aged women (40-44 years). From 1990 to 2021, Australia exhibited stable trends, China experienced increasing burden, Japan saw a decline due to aging, and Korea exhibited mixed patterns influenced by opposing demographic and epidemiological forces. Future projections suggest a stable trend in Australia, declining incidence in China and Japan, and continued burden in Korea.

CONCLUSION

Migraine remains a significant public health challenge across all four countries, with age, gender, and demographic changes playing key roles in burden variations. The study highlights the need for region-specific healthcare strategies and age- and gender-sensitive interventions. Future research should explore socioeconomic, behavioral, and healthcare access factors to refine migraine management strategies.

Prevalence of orofacial and head pain: an umbrella review of systematic reviews

Head pain (HP) and orofacial pain (OFP) are the most prevalent types of pain worldwide, encompassing cranial, oral and facial pain. The aim of this umbrella review was to answer the following questions: "What is the overall prevalence of HP/OFP and the different prevalences of HP/OFP conditions in adults and children?". We searched for studies investigating the prevalence of HP/OFP in four major databases and two databases from the grey literature, based on the following PECOS inclusion criteria: (P)opulation: Adults and children; (E)xposure: Orofacial or head pain conditions such as (1) dental, periodontal and gingival, (2) temporomandibular disorders (TMD), (3) neuropathic conditions, (4) headaches, and (5) idiopathic pain conditions; (C)omparison: None; (O)utcome: Prevalence; (S)tudies: Systematic reviews and/or meta-analyses. We identified 2275 studies and after selection through eligibility criteria, 24 systematic reviews were included. The prevalence of pain in adults for different subgroups ranged from 1.12% for Burning Mouth Syndrome to 80.80% for cancer therapy-related orofacial pain. In children, it ranged from 0.20% for temporomandibular joint osteoarthrosis to 83% for all types of headache. This umbrella review based on available evidence provides integrated data illustrating the highly variable prevalence of head pain and orofacial pain both in adults and children. Considering the high specificity of head pain/orofacial pain, specific public health programs should be developed to address such highly prevalent conditions.

Neuroimmunological effects of omega-3 fatty acids on migraine: a review

Migraine is a highly prevalent disease worldwide, imposing enormous clinical and economic burdens on individuals and societies. Current treatments exhibit limited efficacy and acceptability, highlighting the need for more effective and safety prophylactic approaches, including the use of nutraceuticals for migraine treatment. Migraine involves interactions within the central and peripheral nervous systems, with significant activation and sensitization of the trigeminovascular system (TVS) in pain generation and transmission. The condition is influenced by genetic predispositions and environmental factors, leading to altered sensory processing. The neuroinflammatory response is increasingly recognized as a key event underpinning the pathophysiology of migraine, involving a complex neuro-glio-vascular interplay. This interplay is partially mediated by neuropeptides such as calcitonin gene receptor peptide (CGRP), pituitary adenylate cyclase activating polypeptide (PACAP) and/or cortical spreading depression (CSD) and involves oxidative stress, mitochondrial dysfunction, nucleotide-binding domain-like receptor family pyrin domain containing-3 (NLRP3) inflammasome formation, activated microglia, and reactive astrocytes. Omega-3 polyunsaturated fatty acids (PUFAs), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), crucial for the nervous system, mediate various physiological functions. Omega-3 PUFAs offer cardiovascular, neurological, and psychiatric benefits due to their potent anti-inflammatory, anti-nociceptive, antioxidant, and neuromodulatory properties, which modulate neuroinflammation, neurogenic inflammation, pain transmission, enhance mitochondrial stability, and mood regulation. Moreover, specialized pro-resolving mediators (SPMs), a class of PUFA-derived lipid mediators, regulate pro-inflammatory and resolution pathways, playing significant anti-inflammatory and neurological roles, which in turn may be beneficial in alleviating the symptomatology of migraine. Omega-3 PUFAs impact various neurobiological pathways and have demonstrated a lack of major adverse events, underscoring their multifaceted approach and safety in migraine management. Although not all omega-3 PUFAs trials have shown beneficial in reducing the symptomatology of migraine, further research is needed to fully establish their clinical efficacy and understand the precise molecular mechanisms underlying the effects of omega-3 PUFAs and PUFA-derived lipid mediators, SPMs on migraine pathophysiology and progression. This review highlights their potential in modulating brain functions, such as neuroimmunological effects, and suggests their promise as candidates for effective migraine prophylaxis.

Adjusting for Confounders in Outcome Studies Using the Korea National Health Insurance Claim Database: A Review of Methods and Applications

OBJECTIVES

Adjusting for potential confounders is crucial for producing valuable evidence in outcome studies. Although numerous studies have been published using the Korea National Health Insurance Claim Database, no study has critically reviewed the methods used to adjust for confounders. This study aimed to review these studies and suggest methods and applications to adjust for confounders.

METHODS

We conducted a literature search of electronic databases, including PubMed and Embase, from January 1, 2021 to December 31, 2022. In total, 278 studies were retrieved. Eligibility criteria were published in English and outcome studies. A literature search and article screening were independently performed by 2 authors and finally, 173 of 278 studies were included.

RESULTS

Thirty-nine studies used matching at the study design stage, and 171 adjusted for confounders using regression analysis or propensity scores at the analysis stage. Of these, 125 conducted regression analyses based on the study questions. Propensity score matching was the most common method involving propensity scores. A total of 171 studies included age and/or sex as confounders. Comorbidities and healthcare utilization, including medications and procedures, were used as confounders in 146 and 82 studies, respectively.

CONCLUSIONS

This is the first review to address the methods and applications used to adjust for confounders in recently published studies. Our results indicate that all studies adjusted for confounders with appropriate study designs and statistical methodologies; however, a thorough understanding and careful application of confounding variables are required to avoid erroneous results.

Burden of migraine in patients attending Belgian headache specialists: real-world evidence from the BECOME study

INTRODUCTION

Migraine is a primary headache disorder, which imposes a major burden on the sufferers. The BECOME study (Burden of migrainE in specialist headache Centers treating patients with prOphylactic treatMent failurE) attempted to characterize and assess the prevalence, burden and healthcare resource utilization of migraine patients presenting in specialized headache centers in Europe and Israel. In this paper, we will describe the patient characteristics of the Belgian headache centers.

METHODS

The BECOME study was a prospective, non-interventional, cross-sectional study consisting of two parts. In the first part of the study, data were collected from subjects with a diagnosis of migraine. Subsequently, patients with ≥ 4 monthly migraine days (MMD) and ≥ 1 prior preventive treatment failure (PPTF) filled out validated questionnaires to assess the burden of disease.

RESULTS

In part 1 of the Belgian study population (N = 806), 45% of patients reported ≥ 8 MMD and 25% had failed ≥ 4 preventive treatments. In part 2 (N = 90), more than 90% of patients reported having severe impact of headache on daily life and having severe migraine-related disability. The impact was the highest for patients with ≥ 15 MMD, however, even within the patient population with < 8 MMD, the burden was significant. Almost 40% of the study population suffered from anxiety.

CONCLUSIONS

These findings in the Belgian sample of the BECOME study demonstrate the substantial burden and unmet need for the management of difficult-to-treat migraine.

The impact of migraine and probable migraine on productivity loss in Korea: A cross-sectional online survey

Migraine is an enormous burden on society, but relevant studies are limited. The population of interest of this study was migraine or probable migraine (PM) in Korea. In this population, we aimed to assess the productivity loss through the level of severity defined by monthly migraine days (MMD) and analgesic frequency and to estimate costs and associated factors of productivity loss. We conducted an online survey of adults with migraine symptoms. We defined migraine and PM using the modified International Classification of Headache Disorders, second edition. Severity level was defined by subgroups of MMD (0-3, 4-14, and ≥15 days) and analgesic frequency (0, 1, 2, 3, and ≥4 per week). Productivity loss was assessed using the Work Productivity and Activity Impairment questionnaire and consisted of absenteeism, presenteeism, overall work productivity loss, and activity impairment. The costs of productivity loss due to absenteeism and presenteeism were calculated in 2020 USD. We used negative binomial regression to identify the factors associated with the costs of productivity loss. We identified 362 respondents with migraine or PM. Mean age was 41.7 years, 75.7% were female (N = 274), and 73.2% (N = 265) were employed. On average, productivity losses due to absenteeism and presenteeism were 8.1% and 39.7%, respectively. As MMD increased, there was a trend toward increased activity impairment, presenteeism, and overall work productivity loss. The mean overall productivity loss cost was USD 44.61 per person per day. Duration of migraine attacks was significantly associated with higher absenteeism costs. The results of this study indicate that the higher the MMD, the greater the productivity loss in patients with migraine or PM in Korea. We also found that patients with low-frequency migraine and PM experienced substantial productivity loss. This study provides comprehensive evidence of the burden of migraine in Korea using a representative sample.