Clinical Review

Determinants of Suboptimal Migraine Diagnosis and Treatment in the Primary Care Setting

Journal of Clinical Outcomes Management. 2017 July;24(7)

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Conclusions and Recommendations

Migraine is a prevalent and frequently disabling condition that is underrecognized and undertreated in the primary care setting. Both physician and patient factors pose barriers to the optimal diagnosis and treatment of migraine. Remedies to address these barriers include education of both patients and physicians first and foremost. Targeting physician education in medical school and during residency training, including in primary care subspecialties, could include additional didactic teaching, but also clinical encounters in headache subspecialty clinics to increase exposure. Patient advocacy groups and public campaigns to improve understanding of migraine in the community may be a means for improving patient education and reducing stigma. Patients should be encouraged to seek out consultations for headache to reduce long-term headache disability. Management of comorbidities is paramount, and screening tools for migraine-associated disability, anxiety, depression, and medication use may be helpful to implement in the primary care setting as they are easy to use and time saving.

Recent surveys of PCPs suggest that the resource that is most desired is ready access to subspecialists for advice and “curb-side” consultation [17]. While this solution is not always practical, it may be worthwhile exploring closer relationships between primary care and subspecialty headache clinics, or perhaps more access to e-consultation or telephone consultation for more rural areas. Recently, Minen et al examined education strategies for PCPs. While in-person education sessions with PCPs were poorly attended, multiple possibilities for further education were identified. It was suggested that PCPs having real-time access to resources during the patient encounter would improve their comfort in managing patients. This includes online databases, simple algorithms for treatment, and directions for when to refer to a neurologist [46]. In addition, it may be worthwhile to train not only PCPs but also nursing and allied health staff so that they can provide headache education to patients. This may help ease some of the time burden on PCPs as well as provide a collaborative environment in which headache can be managed [46].

Corresponding author: William S. Kingston, MD, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259.

Financial disclosures: None.