Migraine and chronic daily headache management: implications for primary care practitioners

Learnings and challenges to deploy an interprofessional and independent medical education programme to a new audience

The importance of interprofessional education (IPE) in continuing medical education and professional development has long been recognised by health organisations and academic societies, benefiting not only patient outcomes and interprofessional relationships but also overall health systems and workforce shortage. We report on the outcomes of an Australian IPE activity on medication-overuse headache (MOH) with general practitioners (GPs) and community pharmacists as learners. The design of the activity, which followed the predisposing–enabling–reinforcing instructional framework by Green and Kreuter, aimed to: (1) improve knowledge and foster a willingness in GPs and pharmacists to work collaboratively to enhance the prevention, diagnosis and management of MOH; and (2) address their educational gap by demonstrating the utility of a blended learning IPE strategy on MOH. Integrated into the activity was an assessment of its effectiveness and impact to instil change in the participants’ knowledge of MOH, attitude and willingness to treat, and clinical practice behaviours of GPs and pharmacists to work together. The learners gained knowledge and confidence in diagnosing and managing MOH and in their ability to educate patients. The IPE approach suited the activity and was valued by the participating GPs and pharmacists, who seldom experience such learning formats. However, for educational providers in Australia, developing and deploying an independent medical education (IME) programme can be challenging. Providers of IMEs need to be aware of the potential pitfalls when competing with pharmaceutical-company-sponsored and delivered programmes.

Nurses improve migraine management in primary care

Introduction

Migraine is a common disorder with a high burden. Adequate treatment results in improvement of quality of life. Migraine patients are mainly treated by general practitioners (GPs), but there is still room for improvement. This study investigated whether primary care nurses could improve the treatment of migraine patients compared to usual care as provided by the GPs.

Participants and methods

We conducted a non-randomized controlled prospective trial in 235 patients diagnosed with migraine with or without aura according to ICHD-II criteria, aged between 18 and 65 years. Patients with migraine treated only by their GP were compared to management by a nurse supervised by a GP.

Results

In the intervention group, fewer migraine patients were referred to a neurologist ( p < 0.001). The reduction in monthly migraine days compared to baseline was more apparent in the intervention group at six ( p = 0.09) and nine months ( p = 0.006). There was no significant change in dichotomized HIT score ( p = 0.076). Change in satisfaction of patients did not differ significantly ( p = 0.070).

Conclusions

The care administered by a headache nurse in the primary care setting supervised by a GP resulted in fewer referrals to the neurologist and more migraine-free days per month, but no change in HIT score. There was no difference in satisfaction scores between both groups.

Trigger factors in migraine patients

The objective of this study was to examine potential trigger factors in migraine patients. A total of 126 migraine patients were interviewed about possible trigger factors for migraine. The most common trigger factors were emotional stress (79%), sleep disturbance (64%) and dietary factors (44%). Sleep and stress were significant trigger factors in patients with migraine with aura, whereas environmental factors were important trigger factors in patients with migraine without aura. Stress, sleep and environmental factors were important trigger factors in women and differed significantly from men. Trigger factors are frequent in migraine patients, and avoidance of such factors may result in a better control of the disorder.

General practice physician knowledge about headache: evaluation of the municipal continual medical education program

OBJECTIVE: Headache is a common condition not always managed satisfactorily by primary care providers (PCPs). In an effort to improve headache care, the Curitiba City Hall in consortia with Hospital de Clínicas da Universidade Federal do Paraná - Brazil developed an educational program directed to the PCPs. The goal of the project was to evaluate, to update and to train the PCP on headache knowledge and care. METHOD: The program was designed to have a theoretical phase and a practical phase. Knowledge on headache and medical care of headache were surveyed before and after the theoretical phase thorough a specific questionnaire. RESULTS: Significant improvement in post-CME scores on headache prevalence (p<0.001), migraine diagnosis (p<0.001) and management (p=0.01), secondary headache diagnosis (p=0.005) and management (p=0.005) was reached by the respondents. CONCLUSION: Improvement in post-CME scores confirms that the program had a significant immediate impact on the PCPs knowledge directly affecting the patient's health.