Barriers to Good Medical Care for Chronic Migraine

Patient Expert
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Good medical care is essential for people with migraine, and poorly optimized treatment of episodic migraine is associated with progression from episodic migraine (EM) to chronic migraine (CM). A new study assesses the barriers to the primary elements of good medical care for chronic migraine - medical consultation, diagnosis, and treatment.

The Study

Study Objective:

"To assess the rates and predictors of traversing steps essential to good medical care for chronic migraine, including: (1) medical consultation, (2) accurate diagnosis, and (3) minimal pharmacologic treatment. Candidate predictors included socioeconomic, demographic, and headache-specific variables."

Study Background:

"Previous research has established that barriers to effective management for episodic migraine include the absence of health insurance, lack of appropriate medical consultation, failure to receive an accurate diagnosis, and not being offered a regimen with acute and preventive treatments."

Study Results:

  • Study data was provided by 80,783 participants.
  • 16,789 met criteria for migraine.
  • 1,476 met criteria for chronic migraine.
  • 1,254 met inclusion criteria for this analysis:
    • 512 respondents (40.8%) reported currently consulting with a healthcare professional for migraine.
    • Odds of consulting increased with
      • increasing age,
      • body mass index,
      • migraine-related disability,
      • migraine severity,
      • having health insurance.
    • Among those consulting a healthcare professional:
      • 126 (24.6%) received an accurate diagnosis,
      • 56 of those with a correct diagnosis (44.4%) received both acute and preventive pharmacologic treatments.
      • Odds of a CM diagnosis were higher for:
        • women,
        • those with greater migraine severity,
        • those currently consulting a migraine and headache specialist.
      • No predictors of receiving appropriate treatment were identified among those currently consulting.
    • Among participants with chronic migraine, only 56 (4.5%) individuals successfully traversed the series of three barriers to successful chronic migraine care.

Study Conclusion:

"Our findings suggest that less than 5% of persons with chronic migraine traversed 3 barriers to receiving care for headache (consultation, diagnosis, and treatment), representing a large unmet need for improving care in this population. Predictors of consulting a healthcare professional included age, having health insurance, greater migraine-related disability, and greater migraine symptom severity. Among those consulting, predictors of an appropriate diagnosis included consulting a specialist, female sex, and greater migraine severity. Public health efforts are needed to improve outcomes for patients with chronic migraine by a range of interventions and educational efforts aimed at improving consultation rates, diagnostic accuracy, and adherence to minimal pharmacologic treatment."

Implications and Actions for Patients:

There are definitely barriers to the three essentials of good chronic migraine treatment:

  1. consulting a doctor,
  2. proper diagnosis, and
  3. appropriate acute and preventive treatment.

The statistics are illuminating:

  • Only 40% of study participants had sought medical care.
  • Of those who had sought medical care, only 24.6% received an accurate diagnosis.
  • Of those who received a correct diagnosis, only 44% were prescribed both acute and preventive treatments.
  • Of study participants with CM, only 4.5% successfully overcame the three barriers to successful care.

Patients must not merely sit back and wait for the health care system to address the barriers to care. We must take steps to overcome them ourselves. There are things we can do:

  • Get to a doctor if we haven't been diagnosed or aren't confident of our diagnosis.
  • Educate ourselves about migraine and migraine treatments so we are better able to know if our doctors are diagnosing and treating us appropriately.
  • Don't "settle" until we're sure our diagnosis is correct. If that means having to travel to see a migraine specialist, so be it.
  • Don't hesitate to ask our doctors questions. If they don't want to answer questions, they don't deserve to treat us.
  • Realize that getting the best health care often means needing to be our own best advocates, then find the fortitude to do it.

Resources:

Dodick, David W., MD; Loder, Elizabeth W., MD; Adams, Aubrey Manack, PhD; Buse, Dawn C., PhD; Fanning, Kristina M. Fanning, PhD; Reed, Michael L., PhD; Lipton, Richard B., MD. "Assessing Barriers to Chronic Migraine Consultation, Diagnosis, and Treatment: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study." Headache: The Journal of Head and Face Pain
Volume 56, Issue 5, pages 821–834, May 2016.