Need of guidance in disabling and chronic migraine identification in the primary care setting, results from the european MyLife anamnesis survey

DOI: https://doi.org/10.1186/s12875- 021- 01402- 2

Abstract-Summary The majority of GPs (82%) did not refer patients with chronic migraine (CM) to migraine specialists.

Most GPs (87%) reported a lack of training or the need to be updated on CM

management.

95% of GPs considered that a migraine anamnesis guide could be of use. More than 95% of GPs favoured the use of a patient diary, a validated diagnostic

tool and a validated scale to assess impact of migraine on patients’ daily life.

96% of the GPs considered that the inclusion of warning features (red flags) in an anamnesis guide would be useful and 90% favoured inclusion of referral recommendations.

The results from this survey indicate that more education on diagnosis and man-

agement of CM is needed in primary care.

Better knowledge on the recognition and management of migraine in primary care would improve both prognosis and diagnosis and reduce impact of migraine on patients’ lives, healthcare utilization and societal burden.

Background Headache disorders and in particular migraine, are one of the most prevalent and disabling diseases worldwide [80, 81].

Diagnosis of the three most prevalent headache disorders -tension type headache (TTH), migraine and medication overuse headache (MOH)- is based on medical history or anamnesis [82, 83].

Both diagnosis and management of patients with migraine are often suboptimal

[84, 85].

The European Headache Federation (EHF) recommends that both EM and CM are diagnosed in primary care, but suggests that CM might require specialist man- agement [82].

Several studies have reported that up to 70% of patients with migraine are not

aware of their disease and/or have not been properly diagnosed [84, 86].

The aims of this study were to assess current management of CM in primary care and to evaluate the need by non-migraine specialists for guidance to identify and manage disabling and CM.

Methods My-LIFE anamnesis project was an international, online survey to GPs who are experienced in management of headache disorders, with regard to their current

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practice, perceived needs and important topics for migraine anamnesis in pri- mary care.

The questionnaire for the online survey was designed by a pan-European Steering

Committee with 7 European experts on migraine management.

Simulated consultations were used to gather insights regarding the need and potential usefulness of a migraine anamnesis tool to guide non-specialists in the identification of CM, and to gain information from neurologists, GPs and patients for the development of the survey questionnaire.

Ethics Committee approval was not applicable in this survey because its objec- tive was to understand chronic migraine patients’ management in the primary care setting according to participants recall.

There was no need to collect any type of patient data or information, hence the

approval of an Ethics Committee or patient informed consent was not required.

Results Neurologists felt that an anamnesis guide to identify and manage CM was not needed for migraine specialists but could be useful for GPs.

A total of 201 GPs with experience on the management of headache disorders

from France, Germany, Italy, Spain and the UK participated in the online survey.

Detailed information about how identification, diagnosis and follow-up of patients with episodic migraine and CM are conducted by the GPs in this survey is reported separately [87].

Across countries, only 13% of GPs considered that they had received enough education on the management of patients with CM, and 39% responded that there was a lack of training (from 25% in UK to 55% in Italy, without statistically signifi- cant differences between countries).

Those GPs who did not normally use a patient diary in their clinical practice

found it less important than those who regularly used it (p = 0.036).

Discussion While only 13% of GPs considered that they had received sufficient training on the management of CM, 82% did not refer patients to migraine specialists when CM was diagnosed, in contrast to guidelines recommendations.

Even though the recently updated “Aids to management of headache disorders in primary care” [82] includes a wide variety of tools to support GPs in the iden- tification of CM, in this study, only 18% of GPs considered it necessary to refer their patients to migraine specialists when CM was diagnosed, supporting the need for improved guidance and continuing medical education in the primary care setting.

The recent update of the “Aids to management of headache disorders in primary care” [82], contains a number of tools that have been requested by the GPs in this survey, such as a diagnosis guide of headache disorders including warning features, aids for management of CM, referral recommendations, and a headache diary and calendar.

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Conclusions Our results suggest that GPs would benefit from greater of application of manage- ment guidelines and continuing medical education on diagnosis and management of headache disorders, specifically CM.

Better identification of patients with CM would ensure their better management, and optimal referral to migraine specialists when needed improving patient access to more effective preventive treatments.

Most of the features that GPs considered helpful or mandatory in our survey (i.e., a headache diary, red flags, referral recommendations, and a validated scale to assess impact of migraine on patients’ daily life) are included in the 2019 update of the “Aids to management of headache disorders in primary care” [82].

Acknowledgement A machine generated summary based on the work of Guerrero, Angel L.; Negro, Andrea; Ryvlin, Philippe; Skorobogatykh, Kirill; Sanchez-De La Rosa, Rainel; Israel-Willner, Heike; Sundal, Christina; MacGregor, E. Anne. 2021 in BMC Family Practice.

Exploring Natural Clusters of Chronic Migraine Phenotypes: A Cross-Sectional Clinical Study