Migraine: A better way to recognize and treat it
A prospective study shows how the Migraine Care Program makes management easier and improves patient satisfaction.
In a subgroup analysis, baseline characteristics and end-of-study assessments were summarized separately for Phase 2 patients who reported a pre-study diagnosis of migraine and those who reported no pre-study diagnosis of migraine. Differences between subgroups were compared with chi-square tests as appropriate.
Results
Phase 1 participants
Forty-nine primary care providers (physicians, nurse practitioners, and physician assistants) participated in the Migraine Care Program (TABLE 1). Providers’ mean age was 44 years (SD=8.28). The majority (86%) were in group practice. The number of patients recruited to complete the Headache Assessment Quiz during Phase 1 of the study was 4443.
TABLE 1
Characteristics of study participants
| PRIMARY CARE PROVIDERS | |
| N | 49 |
| Type of provider, % | |
| Physician | 84 |
| Nurse practitioner | 100 |
| Physician assistant | 6 |
| Mean age, years (SD) | 44 (8.3) |
| Female, % | 33 |
| Practice type, % | |
| Group | 86 |
| Private | 14 |
| PATIENTS: PHASE 2 | |
| N | 470 |
| Mean age, years (SD) | 41 (11.9) |
| Female, % | 77 |
| Race, % | |
| White | 85 |
| Black | 6 |
| Hispanic | 6 |
| Other | 2† |
| Medications used for headache during the 3 months before the study,* % | |
| Over-the-counter medications | 70 |
| Triptans | 19 |
| Prescription NSAIDs | 14 |
| Combination analgesic | 9 |
| Narcotics | 5 |
| *Patients could list more than one medication. | |
| †Does not add to 100% because patients could have taken multiple medications. | |
Migraine diagnosis during Phase 1
Of the 4443 patients who completed the Headache Assessment Quiz in Phase 1, 1527 (34%) screened positive for migraine. Of these 1527 patients who screened positive for migraine, 1126 (74% of the 1527 patients screening positive for migraine) had their diagnosis confirmed during further evaluation by their primary care provider (FIGURE 3). More than half (52%) of the 1126 patients with a confirmed migraine diagnosis reported that they had not received a health care professional’s diagnosis of migraine prior to the study.
The proportion of patients with migraine as confirmed by a clinical migraine diagnosis was 25% (1126/4443) in the sample as a whole, which included all patients who had consulted these primary care practices for any reason and who had agreed to complete the Headache Assessment Quiz.
FIGURE 3
Prevalence of migraine among patients who consulted primary care providers for any reason and who agreed to complete the Headache Assessment Quiz
PCP’s perceptions of headache management before and after participation in the program
Primary care providers’ participation in the Migraine Care Program was associated with an increase in awareness of headache impact. At the end of Phase 2 compared with the beginning of the study, significantly more providers rated understanding headache impact as being important or very important in treatment decisions (87% vs 74%; P<.05) (TABLE 2).
Primary care providers’ participation in the Migraine Care Program was also associated with a perceived reduction in the challenges of providing headache care. At the end of Phase 2 compared with the beginning of the study, primary care providers reported assessing and treating headache to be significantly less difficult (median score = 6 at baseline and 3 at the end of the study; P<.001) (TABLE 2).
This improvement was accompanied by the perception of better patient communication about headaches: the proportions of primary care providers indicating that they were satisfied or very satisfied with patients’ descriptions of headache severity/symptoms and headache impact were significantly higher for patients they treated in Phase 2 than for headache patients they had treated prior to the study (76% vs 20% for severity/symptoms; 67% vs 27% for headache impact; P<.001 for both comparisons) (FIGURE 4).
The majority of providers indicated that they were satisfied or very satisfied with the use of the Headache Assessment Quiz as a tool for each of the dimensions assessed: understanding headache severity (88%), understanding headache impact (78%), making treatment decisions (71%), and identifying patients requiring treatment (86%) (FIGURE 4). Nearly all providers (96%) indicated that they would recommend the Headache Assessment Quiz for use in clinical practice (TABLE 2).
TABLE 2
Primary care providers’ perceptions of headache management at baseline and at the end of the study after participating in the Migraine Care Program
| BASELINE | END OF STUDY | |
| Knowledge of headache impact is important/very important in making decisions about treatment, % | 74 | 87* |
| Difficulty in headache assessment, median score† (range) | 6 (2–8) | 3‡ (1–7) |
| Would recommend the Headache Assessment Quiz for use in clinical practice, % | NA | 96 |
| *P<.05 vs baseline. | ||
| †Difficulty was scored on an 11-point scale ranging from 0 (not at all difficult) to 10 (extremely difficult). | ||
| ‡P<.001 vs baseline. | ||
FIGURE 4
Percentages of primary care providers who were satisfied/very satisfied with patient communication and the use of the Headache Assessment Quiz
Patients’ perceptions of headache care by PCPs participating in the Migraine Care Program
Phase 2 sample. The number of patients who participated in Phase 2 was 470 (TABLE 1). Mean age of patients in the Phase 2 sample was 41 years (SD=11.9). The majority of patients were white (85%) and were women (77%).
