Dilemma of migraine diagnosis and management among non-neurologists

DOI: https://doi.org/10.1186/s41983- 021- 00371- 8

Abstract-Summary The aim of the study was to assess the knowledge and attitude of non-neurologists towards migraine.

About 45% of physicians in our study refer migraine patients to non- neurologists, only 20.96% are aware of both classic and novel treatments, 43% had poor knowl- edge of migraine symptoms and management, 32.34% recommended using medi- cal tailored programs to increase the awareness of non-neurologists regarding migraine. There

is a wide gap of knowledge concerning migraine among

non-neurologists.

Extended: There is a knowledge gap regarding migraine among non-neurologists

and more over there is paucity of research from low and middle income countries.

It is also the first study to shed light on the knowledge gap among non- neurologists

aiming to improve patients’ outcome.

Background This could be due to many reasons; including lack of public awareness, physician knowledge and that the management of headache patients could be by a primary physician or other specialties that are not aware of the proper diagnosis and man- agement of migraine [161].

Since most patients with migraine did not receive a correct diagnosis, they mostly depend on over the counter analgesics which if used too frequently can lead to medication overuse headache leading to more disability [81].

The prevalence of migraine was found to be 17% in another study [162], and despite its effect on quality of life, only 8.5% of the patients received preventive treatment [94].

At our country many of the headache patients are seen by physicians other than neurologists, who could be a family doctor, ophthalmologist, otolaryngologist, car- diologist, internal medicine physician or others, this could lead to a proper treat- ment gap, so our study aimed to evaluate the knowledge and awareness of the non-neurologist doctors about migraine diagnosis and management.

Methods Questions assessing knowledge were structured as direct questions with three answering options (yes, no, or I do not know), regarding questions with one correct answer a point was scored for the correct answer, regarding questions with more than one correct answer a point was scored for participants who chose ≥ 50% correctly.

Participants who scored < 50% correct answers were considered to have poor knowledge, participants who scored 50–70% correct answers were considered to

3.2 Medical history

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have average knowledge, participants who scored > 70% correct answers were con- sidered to have good knowledge.

Statistical analysis Descriptive data were represented as mean and standard deviation for continuous variables and as number and percentage for categorical ones.

The chi-square test was used to compare categorical variables, with statistical

significance set at p < 0.05.

Results Most of the participants 91(54.49%) accounted that they refer their patients to neu- rologists, however 76(45.51%) accounted that they refer their patients to non- neurologists; 30 (17.96%) to internal medicine, 25(14.97%) to otolaryngologists, 19(10.78%) to ophthalmology and 3(1.8%) to others.

Most of the participants 128(76.65%) accounted that mild (140 to 159/90 to 99 mmHg) or moderate (160 to 179/100 to 109 mmHg) chronic arterial hypertension can cause headache.

Among the participants, 145 (86.83%) had the knowledge that headache can be a primary disorder, 132(79.04%) had the knowledge that it can be a treatable disorder.

There was significant difference in knowledge regarding years of experience being higher in participants with more years of experience (p = 0.022), there was significant difference showing poor knowledge among participants who gained their knowledge mainly through undergraduate lectures (p  =  0.001), and significantly better knowledge among participants who prefer medical tailored programs (p = 0.010).

Discussion This knowledge gap impacts the management of migraine patients and interferes with reaching a proper diagnosis.

In a study conducted in England, it was found that two-thirds of patients did not

receive proper diagnosis for their headache from primary care physicians [163].

Only 4.19% of participants were able to achieve good knowledge of clinical

characteristics and management tools of migraine.

A study done in Jeddah showed that primary care physicians had low knowledge

levels and inappropriate attitudes toward chronic migraine [164].

This study showed that 54.49% will refer headache patients to a neurologist,

indicating poor referral.

The study had some limitations, as it mainly shed light on migraine rather than all types of primary headache as it was difficult to structure a longer questionnaire. It is also the first study to shed light on the knowledge gap among non- neurologists

aiming to improve patients’ outcome.

Conclusions Knowledge regarding migraine diagnosis and treatment was unsatisfactory among non-neurologists.

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3 Diagnosis

This has a major effect on the level of patients care and detrimentally affects the referral to neurologists consequently affecting the patient’s diagnosis and manage- ment, so it is of utmost importance to address non-neurologists about different types of headache, how to diagnose and how to manage.

Undergraduate lectures proved to be the least effective method of education while medical tailored programs proved to be more effective, so it is important to address members of different specialties according to their preferred method and it is important to enhance the undergraduate programs with updated knowledge and shed light on the importance of such prevalent disorder to provide better manage- ment and lessen its burden.

Acknowledgement A machine generated summary based on the work of Fathy, Mai; ElSadek, Ahmed; Farag, Sherien; Helmy, Shahinaz; AbdElMoneim, Amr. 2021  in The Egyptian Journal of Neurology, Psychiatry and Neurosurgery.

3.3

Clinical Diagnosis

Machine generated keywords: pressure, differential, allodynia, thunderclap, thun- derclap headache, cerebral, european, systematic review, testing, reversible, rela- tionship, differential diagnosis, value, score, systematic

Diagnosis and management of migraine in ten steps