Many patients reluctant to discuss headaches with health care providers
Many patients who experience migraine or headaches either hesitated or never sought medical care for their condition, according to data from two studies presented during the PAINWeek National Conference.
Meanwhile, another study analyzed common migraine-related topics that physicians and patients discussed in the primary care setting.
According to the CDC, 15.3% of U.S. adults have experienced a migraine or severe headache in the past 3 months. These conditions account for about 3% of ED visits each year in the U.S.
More than four in 10 patients hesitated care
For the first study, Robert E. Shapiro, MD, PhD, a professor in the department of neurological sciences in the Larner College of Medicine at the University of Vermont, and colleagues reviewed survey responses from patients in the OVERCOME cohort who hesitated a consultation with a health care professional about their migraine or headache.
Overall, 45% of the cohort (n = 17,920 participants) reported hesitating care. Of these patients, 35% reported being severely disabled by their migraine for an average of 7 or more days per month.
The most common reasons for hesitating care included a desire to self-medicate (45%); a feeling the condition was not “serious enough” to justify a consultation (29%); worry over the cost of such a visit (29%); a feeling their condition would not be “taken seriously” (35%); a concern that health insurance would not cover the visit (21%); and a feeling their present therapy “worked well enough” (12%).
Patients were significantly more likely to have a consult for migraine or headache care if they had health insurance (OR = 1.99), were men (OR = 1.49), resided in an urban or metropolitan area (OR = 1.13), worked full time (OR = 1.24), self-diagnosed their condition (OR = 2.71), experienced nausea during most migraine attacks (OR = 1.15) and did not experience phonophobia during most attacks (OR = 0.85).
Shapiro told Healio Primary Care that the stigma surrounding migraine and headaches may partly explain why patients hesitate seeking consultations for their condition.
The findings help identify areas where clinical care improvements can be made, he said.
“Measures that might encourage increased consulting rates for migraine include providing health care that imparts confidence in an accurate diagnosis of migraine and that assures the person with migraine that this problem will be taken seriously, and lower barriers to care through equitable availability of health insurance,” Shapiro said.
Many patients never sought migraine care
A second group of researchers analyzed responses from 5,430 members of the OVERCOME cohort who had at least mild migraine-related disability but did not present for care in the previous 12 months. Of these individuals, 64% had presented for medical care for their migraine or headache at some point in their lives before the preceding 12 months and 36% had never presented for care.
Susan Hutchinson, MD, a physician at the Orange County Migraine and Headache Center in California, and colleagues wrote that among all 5,430 patients, the mean migraine pain intensity score was seven points (10 points being the most intense pain) for 2 or more days a month.
Compared with patients who never presented for migraine or headache care, those who sought care before the previous 12 months were significantly more likely to be older (mean age of 43.8 years vs. 36.9 years); white (88% vs. 85%); married or living with a partner (58% vs. 56%); have a college degree (39% vs. 33%); have health insurance (90% vs. 88%); experienced at least 4 or more headache days a month (55% vs. 47%); experienced nausea (80% vs. 75%); experienced photophobia (90% vs. 88%); experienced greater pain intensity (7.2 points vs. 6.7 points); experienced moderate or severe migraine- or headache-related disability (64% vs. 59%); indicated moderate- or severe-interictal burden between migraine or headache occurrences (48% vs. 39%); and reported poor or very poor satisfaction with current acute treatment (55% vs. 47%).
In addition, those who had never sought medical care for their migraine or headache were more likely to use over-the-counter medications for the pain (93% vs. 88%). Among all patients who reported hesitating care, those who had never presented for care were also more likely to have a desire to self-medicate (58% vs. 51%), believe their migraine or headache was not painful or serious enough (53% vs. 31%) and were concerned that their migraine would not be taken seriously (58% vs. 51%).
Hutchinson recommended online educational and advocacy groups for patients who are hesitant to seek care for migraine or headache symptoms. The more educated patients are, the “more efficient and less frustrating” their appointments can be, she told Healio Primary Care.
“I would encourage patients to set up a headache-focused visit and ... start keeping a headache diary or calendar and bring it with them to the visit that tracks the number of headache days per month, etc.,” she added.
Migraine discussions in primary care
For the third study, Linda Davis, MD, a physician at Kolvita Family Medical Group in Mission Viejo, California, and colleagues reviewed online survey responses from 6,545 patients who met ICHD-3 criteria for migraine and said their most recent medical-related visit for their migraine in the last 6 months was to a primary care professional. The patients said they averaged 5.9 headache days a month and had a median duration of pain with each migraine or headache of between 5 to 8 hours. In addition, 60% of patients reported experiencing at least moderate disability from their migraine for an average of 4 or more days per month, and 62% were currently taking an acute (non-opioid/non-barbiturate) prescription therapy for the pain.
Davis and colleagues compared responses from participants who had their migraine or headache diagnosed prior to taking the survey and those who did not. These researchers reported that patient-provider conversations mostly included migraine or headache attack-related symptoms (82% vs. 67%), monthly headache days (59% vs. 40%), current acute therapy (56% vs. 37%), monthly days affected by headache (40% vs. 28%) and current preventive therapy (38% vs. 25%), while a less frequent topic included possible acute and preventive therapies that the patient may want to try in the future (20% vs. 14%).
Davis, who said she was mindful of the limited amount of time primary care professionals spend with their patients, recommended that health care providers be direct with their patients about headache-related topics, including attack-related symptoms, monthly headache days, therapies and the impact of their headache.
“This valuable discussion may prompt a provider to consider initiating and/or changing the patient’s treatment plan with the ultimate goal of utilizing evidence-based treatment to reduce the impact migraine is having on the patient’s life,” she said.
CDC. Acute migraine. https://www.cdc.gov/acute-pain/migraine/index.html. Accessed Oct. 18. 2021.
Davis L, et al. Poster 52. Presented at PAINWeek; Sept. 7-11; (hybrid).
Hutchinson S, et al. Poster 93. Presented at PAINWeek; Sept. 7-11; (hybrid).
Shapiro RE, et al. Poster 79. Presented at PAINWeek; Sept. 7-11; (hybrid).