The IRON Registry, launched in 2014, is aimed to disentangle chronic migraine (CM) endophenotypes and to assess patient’s journey, treatment and health care resource use. 

To provide and update of the Italian chROnic migraiNe registry (IRON Registry)

We enrolled all consecutive CM outpatients visited in 24 Italian headache centers from 01/3/2018 to 10/10/2019. Detailed information were gathered with face-to-face interviews using a shared semi-structured web-based questionnaire.

Ninety hundred and thirty-two CM patients were enrolled. Our interim analysis refers to 866 patients (females: 84%; age: 46.4 yrs; monthly headache frequency: 27.7±16.1days). In CM patients, episodic migraine onset occured at the age of 17.4  yrs while chronicization at 35.3 yrs. First headache specialist consultation occurred at the age of 35.3 yrs. Only 23.5% of CM patients used a prophylaxis when migraine was episodic. 

Access to the emergency department during the previous 12 months occurred in 25.3% of patients. Most migraineurs (76.3%) underwent multiple investigations mostly inappropriate (78.1%) and loaded on the national health system (59.6%). Each patient had consulted 8.3+14.5 different specialists for their migraine. Only 1.8% had a disability allowance. 

Patients with near daily CM (≥ 25 days/month) differed from the other chronic migraineurs for younger age at CM onset (p= 0.032), more frequent bilateral pain (p = 0.006), lower triptan (p= 0.04) and higher analgesic use (p < 0.000), lower headache diary use (p <0.000), poorer pharmacological compliance (p= 0.004), more frequent hospitalization (p= 0.045) and emergency department access (p= 0.006). 

Our study reveals low disease awareness and major issues in CM patient’s journey which result in delayed treatment and a considerable burden for our national health system. In particular we document late headache center referral and inappropriate diagnostic and therapeutic strategies. Patients with near daily CM show substantial clinical differences from other CM patients.