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Expert Perspectives on the Interdisciplinary Management of Migraine - Episode 8

Monitoring and Follow-Up of Acute Migraine

A migraine specialist discusses monitoring of patients with acute migraine.

Kita Williams, MD: If a patient has an acute migraine attack and say, for instance, they report to the emergency room, and they’re given something in the ED [emergency department] to stop their migraine pain, which could be an IV [intravenous] cocktail of medications, and then they will need to follow up with someone after that event. The question would be, where would they go from there? What we see is that often they’re told to go back to their primary care provider, especially if they don’t have a neurologist already, and the primary care provider would basically manage that patient. Based on the current knowledge, the multidisciplinary treatment programs appear to be reasonable as well as efficient in treating headache disorders. Often our patients, especially in rural communities, won’t have access to the multidisciplinary approaches to treat migraines. What happens from this point largely depends on how comfortable their primary care physician [PCP] is with treating and managing migraine headaches, it’s not all the same, it’s not a one size fits all. Some PCPs feel comfortable taking this patient from the ED, with their acute migraine attack and saying, how many days are you having them? Let’s put you on preventive medication, but some of them are not comfortable with that. From this point, it’s a case-by-case scenario, many of them get referred to a neurologist, especially if the patient is experiencing frequent headache attacks, like the one that sent them to the emergency room. Because the patient showed up at the ED, a lot of primary care doctors will feel like it’s time to escalate care from this point. In many cases, depending on the comfort level of the primary doctor, patients could be referred to a specialized headache center or to a neurologist who specializes in headache. There’s a role for other modalities of treatment, as well as we discussed earlier in the interdisciplinary approach to the management of migraine. The first step would be to either refer or to assess this patient, determine if they’re having migraines that need to be prevented. Going forward with that, there are medications that we would give for prevention, and there are medications that we would give for the acute management of migraine and that would have to be taken into cover consideration as well.

Trnascript Edited for Clarity