Assessing Physician‐Patient Dialogues About Chronic Migraine During Routine Office Visits

Self Cite

Objective:The ObserVational survey of the Epidemiology, tReatment and Care of MigrainE (OVERCOME; United States) study is a multicohort, longitudinal web survey that assesses symptomatology, consulting, diagnosis, treatment, and impact of migraine in the United States. Background: Regularly updating population-based views of migraine in the UnitedStates provides a method for assessing the quality of ongoing migraine care and identifying unmet needs. Methods:The OVERCOME (US) 2018 migraine cohort involved: (I) creating a demographically representative sample of US adults using quota sampling (n = 97,478), (II) identifying people with active migraine in the past year via a validated migraine diagnostic questionnaire and/or self-reported medical diagnosis of migraine (n = 24,272), and (III) assessing consultation, diagnosis, and treatment of migraine (n = 21,143). The current manuscript evaluated whether those with low frequency episodic migraine (LFEM; 0-3 monthly headache days) differed from other categories on outcomes of interest.Results: Among the migraine cohort (n = 21,143), 19,888 (94.1%) met our International Classification of Headache Disorders, 3rd edition-based case definition of migraine and 12,905 (61.0%) self-reported a medical diagnosis of migraine. Respondents' mean (SD) age was 42.2 (15.0) years; 15,697 (74.2%) were women. Having at least moderate disability was common (n = 8965; 42.4%) and around half (n = 10,783; 51.0%) had consulted a medical professional for migraine care in the past year. Only 4792 (22.7%) of respondents were currently using a triptan. Overall, 8539 (40.4%) were eligible for migraine preventive medication and 3555 (16.8%) were currently using migraine preventive medication.

Section: Discussionmentioning

confidence: 99%

Diagnosis, consultation, treatment, and impact of migraine in the US: Results of the OVERCOME (US) study

Lipton

Nicholson

Reed³

et al. 2022

Self Cite

“…Physicians and practice managers may be able to decrease the number of negative comments through better communication, better organization, and better disposition with a cheerful and empathetic staff . Better communication may include using the ask‐tell‐ask technique, asking patients what their diagnoses or concerns are, and if they have any questions or other concerns not addressed at the end of the visit. Improvements in physician–patient communication could result in a significant decrease in the burden of suffering and the utilization of healthcare resources associated with migraine…”

Section: Discussionmentioning

confidence: 99%

Negative Online Patient Reviews in Headache Medicine

Evans

2018

Patients commonly use online reviews in selecting a new physician. There have been no studies of online reviews of headache medicine physicians. To better understand headache medicine physicians’ attitudes and opinions about negative reviews, 2 negative patient reviews were posted to the Southern Headache Society online discussion group and comments were requested. Twenty‐two anonymous comments are provided. The strengths and inadequacies of online physician reviews in other specialties and the possible actions headache medicine physicians should take for negative reviews are discussed. A nationwide survey of online reviews of headache medicine specialists would be of interest.

“…6 Recent studies show that knowledge and skills gaps persist among both general neurology and primary care physicians around headache care in that they may not use effective open-ended questioning strategies with patients, nor critical measurements and guidelines for diagnosing and treating chronic migraine (e.g., headache days per month and headache-related disability), and they may not prescribe appropriate preventive medications. [38][39][40] Indeed, one study found that primary care physicians are interested in enhanced headache care education. 41 Further, lack of understanding of patients with migraine breeds persistent stigma towards these patients and potential provider depersonalization, which may be mitigated through provider education.…”

Section: Themes Illustrative Quotesmentioning

confidence: 99%

Essential components of care in a multidisciplinary headache center: Perspectives from headache neurology specialists

Goldman

Damush

Kuruvilla³

et al. 2022

Background and Objective: Comprehensive headache care involves numerous specialties and components that have not been well documented or standardized. This study aimed to elicit best practices and characterize important elements of care to be provided in multidisciplinary headache centers.Methods: Qualitative, semi-structured telephone interviews with a purposive sample of headache neurology specialists from across the US, using open-ended questions.Interviews were recorded, transcribed, and coded. Coded data were further analyzed using immersion/crystallization techniques for final interpretation.Results: Mean years providing headache care was 17.7 (SD = 10.6). Twelve of the 13 participants held United Council for Neurologic Subspecialties headache certification. Six described their practice site as providing multidisciplinary headache care.Participants explained most of their patients had seen multiple doctors over many years, and had tried numerous unsuccessful treatments. They noted patients with chronic headache frequently present with comorbidities and become stigmatized. All participants asserted successful care depends on taking time to talk with and listen to patients, gain understanding, and earn trust. All participants believed multidisciplinary care is essential within a comprehensive headache center, along with staffing enough headache specialists, implementing detailed headache intake and follow-up protocols, and providing the newest medications, neuromodulation devices, botulinum toxin injections, monoclonal antibodies, nerve blocks and infusions, and treatment from a health psychologist. Other essential services for a headache center are other behavioral health practitioners providing cognitive behavioral therapy, mindfulness, biofeedback and pain management; and autonomic neurology, neuropsychology, vestibular audiology, sleep medicine, physical therapy, occupational therapy, exercise physiology, speech therapy, nutrition, complementary integrative health modalities, and highly trained support staff.| 307 HEADACHE INTRODUC TI ONComprehensive specialty headache care involves numerous processes, components, and workflow protocols intended to promote delivery of high-quality care. However, these have not been standardized or clearly delineated. Over the years, initiatives have arisen to define and measure quality in headache care, stemming from more general explications of quality in health care. 1 Reviews of quality in headache care include multiple dimensions of quality indicators, standards, and guidelines for outcomes and safety, along with structure, processes, and outcomes of patient care and services. [2][3][4][5] The European Headache Federation, in conjunction with the Lifting The Burden campaign, 6 have proposed criteria for specialized headache centers, including offering multidisciplinary headache care. 7 Currently, there is no certifying body or definitive list of core components requisite or suggested for headache centers in the United States (US).Multidisciplinary treatment has been s...