There are three vital components for appropriate treatment of migraine: 1. consultation with a health care professional, 2. accurate diagnosis, and 3. adequate treatment. If any one of these areas is not fulfilled, a person’s chance of treatment success is diminished. A study presented at the American Academy of Neurology’s annual conference in April found that only 4.5% of people with chronic migraine receive minimally appropriate treatment. Researchers considered a person to be receiving minimally appropriate treatment if they used at least one recommended acute migraine treatment and one preventive treatment.
The study included 1,254 people who met the criteria of chronic migraine. Of those, 512 (40.8%) reported currently seeing a health care professional for migraine treatment. Of those, only a quarter (126 participants) had been diagnosed with chronic migraine or transformed migraine. In people who had been diagnosed, 44.4% were receiving minimally appropriate treatment. Only 4.5% met all three vital components for appropriate migraine treatment.
In the study, the likelihood that a person had seen a health care professional for migraine increased with age, frequency/number of migraine symptoms, degree of disability, and having health insurance. Getting a diagnosis was more likely for women, for those with multiple migraine symptoms, and for those who saw a headache specialist.
Another study presented at the same conference showed that only 28% of primary care providers were aware of the American Academy of Neurology’s guidelines for migraine preventive treatments and 40% knew of the Institutes of Medicine’s Choosing Wisely campaign, which provides migraine treatment recommendations. Medication overuse headache was known to 79% of primary care providers, but only 54% knew that products containing butalbital (Fioricet) can cause MOH and only 34% knew narcotics/opioids can. All this translates into fewer diagnoses and suboptimal care for migraine.
The findings of these studies are deeply disturbing, but they’re also helpful. With this knowledge, doctors can help fill the gaps in treatment and find ways to improve patient care. Patients can act on this information to take charge of their own care by learning about migraine (which you’re doing by reading this article) and advocating for themselves. In her article on the headache specialist shortage, Tammy outlines excellent strategies for getting the best care possible. I recommend taking all her suggestions to heart. All I would add is to take an ally with you to your appointments, if possible. A partner, family member, or friend can help you get your questions answered, can clarify your doctor’s recommendations if you’re too brain-fogged to do so yourself, and can advocate for you if you’re too sick to advocate for yourself.
The research findings are dismal, but that doesn’t mean that people with chronic migraine are out of luck. Instead, it means we have to take and active and proactive role in our care. This can seem daunting and can be exhausting at times, but it’s the only way to ensure that you’re trying the treatments that are best for you and are managing your migraine attacks most effectively.