This article is sponsored by Pfizer.
The diagnosis and treatment of migraine, a debilitating neurological disease that affects nearly 40 million people in the U.S. and one billion worldwide, is poised for a transformation, and primary care physicians (PCPs) hold the key.
Migraine is the most common diagnosis among patients presenting with headache in the primary care setting. More than 50 percent of all visits for migraine take place in primary care, making PCPs the de-facto front line for diagnosis and treatment. There are fewer than 1,000 headache specialists who are certified by the United Council for Neurologic Subspecialties (UCNS) and/or hold a Certificate of Added Qualification in Headache Medicine (AQH) from the National Headache Foundation and it takes an average of 15 months to see one. Therefore, it is essential for patient outcomes that PCPs are empowered and confident to treat migraine.
Armed with a deeper understanding of the impact of migraine disease and tools that enhance migraine diagnosis, combined with the availability of effective and tolerable treatment options, PCPs can seize the moment and make a meaningful difference in the lives of people with migraine.
Understanding the impact of migraine
Through my background as a primary care physician and headache specialist, I’ve sat across from many people who have described to me their daily struggles with migraine disease. Most of all, they speak of migraine’s most difficult burden: the disease’s ability to rob people of time. Migraine puts people on the sidelines, causing them to miss time with loved ones and be absent from work, school and social engagements. It’s no wonder that, globally, migraine is the second most common cause of disability, with approximately 45 million years lived with disability. That’s more than asthma and diabetes combined. The disabling effect of migraine is further illuminated when observed at the individual patient level.
Improving efficiency in migraine diagnosis and management
For people with migraine, days matter. The more efficiently people can receive an accurate diagnosis of migraine the less time it will take to access treatment that can relieve their pain and lessen the burden migraine places on their life. In fact, research shows that patients without optimized acute treatment are more likely to have their migraine disease get worse. Primary care has the potential to reduce the number of patients who progress to a more severe, debilitating disease by providing them with effective treatment earlier in their migraine journey.
This is why PCPs are essential to diagnosing and treating headache disorders, including migraine. A time-efficient approach to diagnosing migraine starts with a baseline recognition that migraine is more than a headache. Migraine is a neurological disease that is most often defined by pulsating and disabling headaches accompanied by nausea/vomiting, as well as sensitivity to light and sound. A migraine attack can last from 4 to 72 hours, which is longer than a typical headache.
Screening tools for your practice
Since the symptoms of migraine disease can vary from person to person, a number of screening tools can help you better assess your patient’s headache history and support a more accurate diagnosis. Among these is the ID Migraine™ Screener, which relies on three simple questions to support your consultation:
- Has a headache limited your activities for a day or more in the last three months?
- Are you nauseated or sick to your stomach when you have a headache?
- Does light bother you when you have a headache?
The ID Migraine™ screener tool has been validated to show that when a patient responds affirmatively to two or all three questions, a migraine diagnosis is likely. Moreover, this and other readily available screening tools can help empower a more collaborative doctor-patient relationship that can aid in diagnosis and inform treatment decisions.
Understanding migraine-associated symptoms and relying on tools and guidance will help you more easily incorporate a time-efficient approach to migraine management in your practice.
Migraine treatment landscape continues to evolve.
Thanks to a recent evolution in migraine medicine, PCPs have innovative therapeutics at their fingertips for elevating migraine management in primary care. These therapies include a range of oral medications such as calcitonin gene-related peptide (CGRP) receptor antagonists that block the CGRP receptor believed to be a cause of migraine, as well as triptans which block pain pathways. Injectable medications, which are monoclonal antibodies that target either the protein CGRP or its receptor, can also be used for preventing migraine or reducing the frequency of attacks. Some patients may prefer infusion therapy which can enable various medications to be administered intravenously. Triptans are also part of a class of intranasal medications, which also includes dihydroergotamine, that offer the potential to fill the gap for people with migraine who require more than one treatment option.
Bradley Torphy is a family physician and headache specialist with a Certificate of Added Qualification (AQH) in headache medicine from the National Headache Foundation. He is actively involved in research in the field of headache medicine. He is the founder, Chicago Headache Center and Research Institute.