Studies have shown that primary care physicians as a group need more training and education to better prepare them to accurately diagnose and treat migraine, which remains one of the most misunderstood forms of headache, despite its heavy burden on patients in the US.
Migraine remains one of the most misunderstood forms of headache, despite its heavy burden on patients in the US. According to the American Migraine Foundation (http://bit.ly/qv9ZkV):
According to the American Headache Society Primary Care Migraine Partnership (http://bit.ly/rJhN5B), up to two-thirds of migraine sufferers seek care in the primary care setting. This, combined with the sheer numbers of migraine sufferers in the US and the severe impact of this condition on patients’ quality of life, highlights the need for expanded training and education on the recognition and appropriate management of migraine for primary care physicians.
The International Association for the Study of Pain (IASP) and the International Headache Society recently announced the launch of a year-long campaign to raise public awareness of headache disorders and educate health care professionals about specific topics related to headache.To help educate primary care physicians and other clinicians who diagnose and treat patients with migraine, the IASP has created a host of fact sheets and other resources. These include:
The accurate differential diagnosis of migraine can be a challenge for primary care physicians and other non-specialists due to the often complex clinical presentation of this condition, symptoms of which often overlap with other headache types. Because it “often presents as tension-type headache, sinus headache, probable migraine, ‘period’ headache, muscular neck pain, cyclic vomiting, and ‘stress’ headache,” migraine has been called the “great masquerader” (http://bit.ly/rAhAmm).
The National Headache Foundation reports that migraine is misdiagnosed as tension or sinus headache “almost as frequently as it is correctly diagnosed” in the primary care setting (http://bit.ly/sBGCj6), with some estimates pegging the rate of misdiagnosis as high as 50% of cases (http:// bit.ly/rXJwXP). This is in line with findings from other studies that looked at primary care physicians’ “knowledge, attitudes, and beliefs regarding migraine,” such as the study by Patwardhan and colleagues in Headache (http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2006.00427.x/abstract), which concluded that primary care physicians “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.”
To meet this perceived gap in knowledge and training regarding migraine, The International Association for the Study of Pain (see sidebar), The Primary Care Network (which offers CME programs such as “Chronic Migraine Dx; http://bit.ly/ uE463t), and other organizations have created resources designed to help primary care physicians better understand the diagnostic criteria and management strategies for this common painful condition.