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Expert Perspectives on the Interdisciplinary Management of Migraine - Episode 2

Awareness and Diagnosis of Migraine in Primary Care Clinics

Dr Williams talks about the journey of a typical patient and awareness and diagnosis of migraine symptoms in primary care settings.

Kita Williams, MD: Concerning the level of awareness and recognition of migraine symptoms in primary care clinics and community settings, most patients are going straight to a primary care facility. They are the front line for pretty much everything that our patients are experiencing. The patient will see their primary care provider with a complaint of headache. They may not call it a migraine. They may call it any number of things.

We often find that many primary care physicians aren’t properly educated on how to assess a migraine. They do a great job, but oftentimes patients aren’t fully or adequately diagnosed with migraine. What’s needed is for this diagnosis to be based on signs and symptoms taken in history—characteristic features of the patient’s headache. Many people with migraines will remain undiagnosed because of this. There was a study that assessed how much the primary care providers understand the migraine diagnosis criteria, and it showed that as low as 10% knew the entire criteria for migraine. It’s a lengthy list. What we’re looking for—and what needs to be assessed—is that the patient has at least 5 headache attacks that last 4 to 72 hours, either untreated or treated unsuccessfully. The headache must have at least 2 of these, with a unilateral location, a pulsating quality, a moderate or severe pain intensity, aggravation caused by activity, or nausea or vomiting. Of the last 2, they need to have at least 1: nausea or vomiting or photophobia and phonophobia. They don’t have to have all 4, but nausea and/or vomiting, or photophobia and/or phonophobia. When you get that patient, keep these things handy and nearby in the diagnosis of migraine.

Regarding patients and how they’re experiencing this, often it’s because of common misconceptions and misunderstandings, and a patient can delay their own treatment. I’m going to walk through how a patient generally sees this thing. A patient with migraine will suffer in silence because their disease is misunderstood. Families and coworkers try to be sympathetic, but often they don’t understand the patient. Because of this, the migraine is often dismissed as a headache. Understand that migraines have the power to disrupt a person’s life completely. There’s no empirical test for migraine, so people feel as if they can’t seek help because there’s nothing they’re going to find out. They’re often not believed; they become their own toughest critic. They think that their headache will elicit a negative reaction from friends and colleagues because they’re going to have to take off work, or they can’t go to the family reunion. This forces them to push through, give it their best effort, do what they must do.

I spoke with a nurse recently who has migraines, and she mentioned that she would strap an ice pack to her head and work in the emergency department with a migraine just so she could press through. These are the kinds of things people are doing. Even in the health care field, she wasn’t seeking the help she needed. We realize that patients are experiencing an emotional component as well. We’ll talk more about that in a moment, because migraines aren’t just physical. Living with chronic pain or a constant worry that a migraine is going to strike at any moment can be mentally devastating, and can take an emotional toll on a person. These are all things the migrator has to go through, and sometimes that can be what prevents them from seeking the help that they need.

Transcript Edited for Clarity