Managing migraine in primary care: 5 things to know

Overall, migraine is second among the leading causes of years lived with disability. Migraine affects approximately 15% of the American population and is one of the The most common and the debilitating conditions faced by primary care providers (PCPs). On 1 out of 10 patients complain of headaches to their PCP and 75% of these patients suffer from migraine. Yet this condition often goes undiagnosed.

Here are five things to know about successful migraine management in primary care.

1. Migraine is a chronic neurological disorder, not an episodic headache.

As our knowledge of the pathophysiology of migraine has evolved, we have come to understand that this condition is a inherited, chronic neurological disease with recurrent episodic seizures.

Migraine is a debilitating brain condition influenced by both genetics and environment, and is characterized by throbbing headache attacks and sensitivity to movement as well as visual and auditory stimuli. Symptoms irritability, yawning, fatigue and difficulty concentrating may precede migraine attacks by 1 to 2 days; attacks are followed by hours of fatigue and malaise. They can last 4-72 hourswith 90% of patients reporting moderate to severe pain and more than 50% reporting severe impairment or reduced productivity. Additionally, migraine is a lifelong chronic disorder, with age-related changes in clinical presentations and prevalence.

2. Migraine is often misdiagnosed and undertreated.

Migraine is often misdiagnosed like a sinus headache. A study of nearly 3,000 patients with self-described or physician-diagnosed migraine demonstrated that 88% of participants had migraine, not sinus headaches, and had neither a correct diagnosis nor the proper treatment with disease-specific medications. headache. the American Migraine Study II showed that nearly 50% of the more than 30,000 participants diagnosed with migraine were unaware they had the disease before entering the study. Among the most common misdiagnoses was sinus headache.

And more recently, in a small study of 130 patients, 81.5% of participants were misdiagnosed with sinusitis. Of the misdiagnosed patients, nearly 88% were treated medically and just over 12% were treated surgically, with no symptom relief in nearly 85% and 77%, respectively. Yet migraine improved in about 69% of patients with proper diagnosis and treatment.

It is necessary for PCPs to be knowledgeable and willing to diagnose and treat migraine. A lot PCPs may hesitate prescribing migraine preventive medications due to unfamiliarity with treatment guidelines and new therapies. Primary care management of migraine remains suboptimal, resulting in an average gap of 4 years between diagnosis and initiation of preventive medication. Out of more than 40% Of patients who meet criteria for migraine prevention, approximately 75% are not currently using migraine preventative medication or triptans to interrupt an acute attack.

To help improve headache management, the American Academy of Neurology has developed a set of quality measures for headaches. They include frequency documentation, counseling, acute management, and preventive management as migraine-specific quality measures.

3. There are different ways to approach migraine management.

Effective treatment for migraine includes a combination of therapies. Educating patients about these therapies is the first step towards successful management of this condition. Although not all patients are ready to start pharmacological therapies, many are willing to try at least one of the treatments recommended by the American Academy of Neurology and the American Headache Society. These treatments include:

Decisions regarding the use of pharmacological or non-pharmacological approaches depend on several factors. Treatment plans must be individualized, and selection of the type of treatment is at the discretion and comfort level of the clinician.

4. Prevention is the cornerstone of management.

As with many chronic conditions, prevention is key to migraine management. Migraine is classified as episodic (up to 14 headache days per month) or chronic (15 or more headache days per month). The American Headache Society Consensus Statement recommends offering preventive management of patients with migraines six or more days per month.

Modern understanding of the pathophysiology of migraine has changed the treatment paradigm, ushering in a new era of migraine-specific therapies, including 5-hydroxytryptamine 1F (5-HT1F) receptor agonists as well as monoclonal antibodies and calcitonin gene-related peptide (CGRP) receptor antagonists. Target the CGRP course may be the first migraine-specific targeted preventative option in the history of headache medicine, potentially revolutionizing management.

Successful treatment may consist of a combination of acute and preventive therapies. Preventative treatments can include pharmacological therapies, neuromodulation devices, and behavioral therapies. Preventive management of migraine may lead to a better response to acute treatment; decreased frequency, duration and severity of attacks as defined by patients; reduction in migraine-related disability; improved health-related quality of life; and reduction of psychological distress.

5. Improving migraine education for primary care providers is essential.

There are no standardized approach teaching headache medicine in medical schools or in physician assistant or nurse practitioner programs. Education in headache medicine varies from institution to institution. Most graduates have not received the necessary training to recognize and treat headache disorders. With this in mind, several reputable national organizations have developed programs to improve the management of migraine in the primary care setting.

The American Headache Society created the First contact – Headache in Primary Care website to provide guidelines, educational resources, free Continuing Medical Education (CME) credits and migraine management organizational chart. Launch of the National Headache Foundation Migraine in primary care, a free web and app-based training program that provides PCPs with free CME credits while learning about the latest migraine treatments and protocols. And the Association of Migraine Disorders offers A migraine toolboxa comprehensive CME course that covers practical approaches to diagnosis and treatment, plus resources such as quizzes, medication guidelines for clinicians, and patient brochures.

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About Antoine L. Cassell

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