Practice recommendation
- Consider using the Headache Assessment Quiz, which 76% of providers in this study said enabled patients to adequately convey headache severity/symptoms, compared with just 20% of providers at baseline who thought patients communicated clearly.
- Use the quiz also to better understand the impact of migraine on a patient’s life, and to help determine which patients need migraine-specific therapy.
Up to 25% of patients in a typical primary care practice could be afflicted with migraine, and many of them simply do not report their headaches. Their silence does not necessarily imply adequate control with self-medication. Other concerns may command their attention, or inadequate communication may mask the issue. Whatever the reason, too few of them receive migraine-specific medications and proper instruction on avoiding headache triggers that could relieve the well-known burden of this disorder. Our study verifies the success of a program for screening—including a Headache Assessment Quiz—and treating migraine that also eases the burden of management for you.
For more original research on the treatment of migraines, see “Do family physicians fail to provide triptans for patients with migraine?”
We begin with a summary of our findings, and then give a detailed account of our study methods and results.
How many patients are slipping through the cracks?
Nearly half of all persons with migraine in the United States have not received a diagnosis for their disorder.1 Many of them suffer substantial functional impairment in daily activities and, thus, a diminished quality of life.
What’s to blame for this underdiagnosis? Perhaps a person’s failure to consult a physician for headache, poor patient-physician communication, comorbid conditions that obscure the presence or significance of headache, or a lack of time and resources devoted to detecting and managing migraine in the health care setting.2-5 In 2 recent studies conducted mainly in primary care settings, the frequency of unrecognized migraine among patients consulting for headache ranged from 48% to 60%.6,7
Even when migraine is recognized, quality of care is often suboptimal. In 1999, only 4 of 10 US migraineurs used prescription medication for migraine.6 In a recently published study that used 2002–2003 retrospective data from more than 30 managed care organizations, 50% of patients with a migraine diagnosis who had prescription drug coverage filled a prescription for a medication commonly used to treat migraine.8
We need a reliable system for migraine detection and management.
Migraine Care Program proves its worth
The Migraine Care Program (at www.migrainecareprogram.com) is a disease-management program employing educational materials and clinical assessment tools to help health care providers and patients improve awareness and recognition of migraine and the quality of care received by migraine sufferers. Components of the program:
- Informational modules on migraine epidemiology, pathophysiology, diagnosis, triggers, impact, and treatment
- Headache diary for patients
- Action plan for patients to complete with their health care providers
- Information for patients on effectively communicating with their health care providers about headache
- 10-question Headache Assessment Quiz and its supplement, which screen for the presence of migraine (FIGURE 1)
- 6-item Headache Impact Test (HIT-6) (FIGURE 2), a reliable, valid measure of the impact of headache on patients’ lives.9
This article reports the results of a prospective, two-phase study undertaken to assess (Phase 1) the utility of the Headache Assessment Quiz in facilitating recognition of migraine; and (Phase 2) the usefulness of the Migraine Care Program from the perspectives of both primary care providers and their patients. The study is unique in being one of a few to assess the effectiveness of a disease management program in improving patient outcomes or influencing physician’s behavior.
FIGURE 1
Headache Assessment Quiz
FIGURE 2
Headache Impact Test: HIT-6 (version 1.0)
How we measured success
In our study, primary care providers using the Migraine Care Program’s Headache Assessment Quiz as a screening tool diagnosed migraine in 25% of 4443 patients. That 1 in 4 patients consulting these primary care clinics for any reason had migraine is consistent with the estimated prevalence of migraine in the general population.1 More than half (52%) of those given a clinical diagnosis of migraine in this study had not previously received the diagnosis, which is also consistent with previous figures on unrecognized migraine.1,6,7 This pattern of results suggests that provider education and use of the Headache Assessment Quiz facilitated recognition of migraine in this sample.
Providers said the Headache Assessment Quiz improved management decisions. Three of 4 (74%) patients who tested positive for migraine on the Headache Assessment Quiz were subsequently given a clinical diagnosis of migraine after further evaluation by the primary care provider. Providers’ ratings of the Headache Assessment Quiz indicate the tool proved useful in multiple aspects of migraine care: understanding headache severity and impact, facilitating treatment decisions, and identifying patients requiring treatment. By the end of the study, providers found headache patients less difficult to assess and manage than before.