Migraine Diagnosis and Treatment: A Knowledge and Needs Assessment among Primary Care Providers (S23.006)

Objective: To assess primary care providers’ (PCP) knowledge and needs regarding migraine diagnosis and management. Background: Studies reveal that migraine is often under-recognized, misdiagnosed and inadequately treated in the primary care setting. Methods: We held focus groups and distributed a brief questionnaire to PCPs at an affiliate hospital. PCPs were asked knowledge based questions and about the difficulties they have encountered in diagnosing and treating migraine patients. Building upon this information, we developed a comprehensive survey in our academic medical center assessing PCPs’ knowledge about migraine. Descriptive analyses were performed. Results: The initial focus group discussions and brief questionnaires revealed that PCPs are aware of the prevalence of migraine but are uncertain about the details of the management of these patients. 83/120 physicians completed the comprehensive survey. Physicians do not know the indications for when MRI brain is warranted; 47[percnt] would order one for a new type of headache, 31[percnt] would order one for a worsening headache, 35[percnt] would order one for a headache not responsive to treatment. Only 28[percnt] were familiar with the AAN guidelines on preventive treatment and 40[percnt] were familiar with the IOM Choosing Wisely Campaign recommendations on migraine treatment. 79[percnt] have heard of medication overuse headache (MOH) but only 54[percnt] are aware that butalbital containing products can cause MOH and only 34[percnt] are aware that narcotics can cause MOH. Few patients are reportedly referred for evidence based non-pharmacologic treatments. PCPs favored opportunities for direct contact with physicians (56[percnt]), lunchtime staff meetings (46[percnt]), and embedding a neurologist in the clinic to see patients and whom they can curbside for questions (39[percnt]). Conclusions: PCPs may not be aware of the specific recommendations for managing migraine patients. Future work should focus on innovative ways to provide decision support and education to PCPs who are caring for patients with migraine. Disclosure: Dr. Minen has nothing to disclose. Dr. Tishler has nothing to disclose. Dr. Loder has received personal compensation in an editorial capacity for British Medical Journal. Dr. Silbersweig has nothing to disclose.