Abstract
Dear Editor,
Following Dr Panconesi’s remarks, we need to discuss again a few aspects that we thought had already been well explained in our article (1).
In Italy, all people aged 18 years or over are obliged by law to choose as their general practitioner (GP) one of the physicians that have been specially authorized to practice as a GP by this country’s National Health Service. The maximum number of patients that any single GP may have in his/her practice is 1500. As this obligation applies to all subjects ≥18 years, among the names included in the GP’s practice list there may well be people who do not have any disease.
Therefore, an epidemiological survey of past-year prevalence of migraine conducted in the entire practice of a GP of any Italian city or town may be considered representative of the general population of that city or town, as long as: (a) it does not show significant differences in gender and age range compared with the overall adult population living in the same city or town; and (b) at least 70% of the starting sample is recruited for the study.
The study that we conducted in full compliance with the above criteria was an epidemiological survey of migraine prevalence in a sample representative of the adult general population living in the city of Parma (Italy). Therefore, it has nothing to do, and cannot be compared, with the studies reported by Panconesi, which concern clinical populations of patients seeking treatment at Primary Care facilities (2) or migraine diagnoses recorded in the databases of Italian GPs (3–5).
In our study, the GP’s contribution was merely: (a) to supply names and addresses of all subjects (not necessarily patients) included in the list, who had chosen the physician as their GP; and (b) to make a room available next to the doctor’s office where we could interview the people in the GP’s practice list that had come to the office for a variety of reasons (not just because they needed a medical visit, but also because they needed to have some administrative tasks performed for themselves or their family members). No subject selection was made by the GP.
Apart from those considerations, certainly the migraine prevalence rate that we found in our study is higher than that reported on average in the other studies conducted in comparable samples representative of the general population. A possible explanation for this difference has already been discussed in our article (1), and in the interesting editorial by Gudmundsson and Scher (6).
Finally, we agree with what Panconesi reports in the first and second points of his remarks. The great majority of subjects that we found to suffer from primary headache had never sought treatment from their GP for their headache and were not taking triptans. These aspects are certainly interesting and we plan to discuss them in detail in one of our next articles.