title: Recognition and management of migraine in primary care: influence of functional impact measured by the headache impact test (HIT).
abstract: The objective of the present study was to investigate the influence of headache-related disability on the recognition and management of migraine by French general practitioners (GPs). Forty-nine teaching GPs at the Faculty of Medicine in the Nice-Sophia-Antipolis University were involved in this study. On one day, each patient who presented during the surgery hours of these GPs was invited to complete a questionnaire aimed at identifying if he/she was a headache sufferer and, if so, whether the headache corresponded to migraine and had an impact on his/her functional ability. Functional disability was measured by the short-form of the Headache Impact Test (HIT-6). Being blind to the patients' responses, the GPs completed a questionnaire for each patient aimed at identifying if he/she considered the patient to suffer from migraine and, if so, whether he/she managed the patient for migraine. A total of 696 patients were included in this study and 289 (41.52%) of them had episodic headache. According to the new International Headache Society (IHS) criteria, 113 (16.24%) patients suffered from headache without migrainous features and 176 (25.29%) patients were migraine sufferers (migraine according to IHS categories 1.1 and 1.2.1: 11.21%, and probable migraine according to IHS categories 1.6.1 and 1.6.2: 14.08%). The mean HIT score of these migraine sufferers was 59.1+/-8.8 and 50% of them presented with a very severe impact score (HIT score>60). Among the 176 migraine sufferers, 105 (59.7%) were not recognized as having migraine, 21 (11.9%) were recognized as having migraine but without migraine management and 50 (28.4%) were recognized as having migraine with migraine management. Recognition of migraine by GPs was statistically associated with the HIT score (OR=1.105, 95% CI: 1.056-1.157, P<0.001) and with the 1.1 and 1.2.1 IHS diagnostic categories (OR=2.942, 95% CI: 1.286-5.025, P=0.0107) whereas management of patients recognized as having migraine was only associated with the patient's age (OR=1.051, 95% CI: 1.000-1.104, P=0.0486). These results indicate that the continuing medical education of GPs should focus on the diagnosis of migraine and its impact on the lifestyle of the patient.
authors.affiliation: Department of Evaluation and Treatment of Pain, Hospital Pasteur, Nice, France.
authors.forename: E Vuillaume
authors.initials: EV
authors.lastname: De Diego
authors.forename: M
authors.initials: M
authors.lastname: Lanteri-Minet
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D004185:Disability Evaluation; D005260:Female; D005602:France / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D010147:Pain Measurement / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D018434:Sickness Impact Profile; D016037:Single-Blind Method