Migraine Knowledge Gaps Among Women’s Health Care Providers

Women’s health care providers’ may benefit from headache-specific education to improve knowledge gaps regarding the management of migraine in their patients, according to a new study.¹

Migraine is often underdiagnosed and inadequately treated in the primary care setting.¹ In women particularly, migraine is one of the leading serious health problems, according to the Migraine Research Foundation. Of the more than 39 million Americans who suffer from migraines, 28 million are women.²

The study, which was published in Headache, included a comprehensive survey assessing of migraine knowledge among primary care providers (PCPs), with an added section on the use of hormonal medication in patients with migraine.¹

Overall, 115 women’s health care providers completed the survey. Based on the findings, women’s health care providers generally recognized the prevalence of migraine, but experienced knowledge gaps regarding management.¹

Although 82.6% of respondents said they feel comfortable or somewhat comfortable diagnosing a migraine, only 57.9% reported routinely asking patients about headaches during annual visits. Additionally, only 6.3% were familiar with the American Academy of Neurology guidelines on preventative treatment and 17.3% were familiar with the Choosing Wisely Campaign recommendations on migraine treatment. Many reported prescribing medications known to contribute to medication overuse headache.¹

Notably, only 37.5% of respondents reported having migraine and headache education, and most (96.3%) indicated interest in migraine prevention and treatment, migraine associated disability, and diagnostic testing.¹

Other findings from the study:¹

• Only 24.3% would order imaging for a new type of headache, 35.7% for worsening headache, and 47.8% for headache with neurologic symptoms.
• Respondents had limited knowledge of evidence-based, non-pharmacologic treatments for migraine (ie, biofeedback or cognitive behavior therapy), with nearly none placing referrals for these services.
• Most providers were comfortable prescribing hormonal contraception (mainly progesterone only) to women with migraine without aura and with aura, and followed guidelines to limit combination hormonal contraception for patients with aura.

Pharmacists can play an important role in providing education on migraine prophylaxis for better patient outcomes in the primary care setting. A study presented at the American Society of Health-System Pharmacists Midyear 2020 Clinical Meeting and Exhibition indicated that pharmacists can offer provider education on drug selection and the impact of acute medication overuse, as well as identifying when migraine symptoms are not well controlled.

References

1. Verhaak AMS, Williamson A, Johnson A, et al. Migraine diagnosis and treatment: a knowledge and needs assessment of women’s health care providers. 2020. Headache. https://doi.org/10.1111/head.14027
2. About migraine. Migraine Research Foundation. Accessed January 15, 2021. https://migraineresearchfoundation.org/about-migraine/migraine-in-women/