You probably know that all doctors are not the same when it comes to treating Migraine disease. We generally turn to our primary care physician (PCP) first for whatever care we need and go from there. Unfortunately, even the best intentioned PCP has an overly full plate of so many conditions to treat that he or she may not know much about Migraine.
In 2000, the U.S. Headache Consortium published guidelines for treating headache and Migraine with this objective:
"The objective of the US Headache Consortium was to develop scientifically sound, clinically relevant practice guidelines on headache, for use in the primary care setting. Practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. For the guidelines on chronic headache, these included diagnostic approach, acute and preventive pharmacologic treatment, and non-pharmacological measures."
Dr. Eric Wall, a Consortium member, explained,
"The main thrust of the guidelines is to help physicians think out an overall management plan that is tailored to the individual. A systematic approach to Migraine management has been lacking until now ... The patient plays a big role in treatment, and this aspect of therapy is integrated throughout the guidelines ... If you don't feel you're included in your care, find a doctor who will listen and help you get involved."
The American Headache Society has a continuing medical education (CME) program called BRAINSTORM that encourages PCPs to adopt the Consortium's guidelines. An article in Headache: The Journal of Head and Face Pain reports on a study to measure the knowledge of a group of PCPs before and after the BRAINSTORM CME program.
The stated objective of the study was to "use a presurvey of primary care providers (PCPs) enrolled in a continuing medical education (CME) program on headache management to ascertain their existing knowledge, attitudes, and beliefs regarding migraine and use a postsurvey to determine the extent to which the CME program has brought participant knowledge, attitudes, and skills closer to conformance with best evidence."
Study methods:
- A 20-item questionnaire was developed covering the essentials of Migraine care.
- The questionanaire was administered before and after a BRAINSTORM presentation to 254 PCPs attending a medical meeting.
- A control group of 112 comparable physicians not attending the meeting completed the questionnaire.
- Prepresentation scores of meeting attendees were compared to scores of nonattendees to assess the generalizability of results.
- Prepresentation scores were used to assess the physicians' baseline knowledge, attitudes, and beliefs.
- Pre- and postpresentation scores were compared to assess the effectiveness of the BRAINSTORM CME program.
Study Results:
- Prepresentation scores of attendees and nonattendees were similar.
- There was a statistically significant difference between pre- and postpresentation scores for 16 of the questionnaire's 20 questions.
- In the pretest, all participants scored lower than 66% on 2 questions related to prevalence, impact, and pathophysiology of Migraine, 2 questions pertaining to history taking/physical examination, and 3 Migraine management questions.
- Scores of physicians completing BRAINSTORM improved to higher than 66% posttest on all except 2 questions related to prevalence, impact, and pathophysiology of Migraine.
Stated conclusion of the study:
"Our results indicate that PCPs need to acquire greater understanding about the epidemiology and pathophysiology of migraine and may require guidance in history taking and physical examination of migraine patients. Improvement in scores posttest confirms that the BRAINSTORM program has a significant immediate impact on the knowledge, beliefs, and attitudes of participants. The program could be strengthened to improve emphasis in some areas where posttest scores showed no improvement."
Summary:
Diagnosis, treatment, and management of Migraine disease can be frustrating for
both patient and physician. Although it would be unrealistic to envision a time
when PCPs would be able to manage all Migraine cases, it is reasonable to hope
for a time when all physicians have basic knowledge of the disease. Gone should
be the days of physicians saying...
- "It can't be a Migraine if you don't have an aura."
- A Migraine can't last for five days."
- "Young children don't have Migraines."
- "A hysterectomy will stop those Migraines."
The dedicated members of the American Headache Society and U.S. Headache Consortium are working to make this happen.
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Resources:
Patwardhan, Meenal B., Samsa, Gregory P., Lipton, Richard B. & Matchar, David
B. (2006) "Changing Physician Knowledge, Attitudes, and Beliefs About Migraine:
Evaluation of a New Educational Intervention." Headache: The Journal of Head
and Face Pain 46 (5), 732-741. doi: 10.1111/j.1526-4610.2006.00427.x
