title: In-office discussions of migraine: results from the American Migraine Communication Study.
abstract: BACKGROUND
  Research indicates that successful migraine assessment and treatment depends on information obtained during patient and healthcare professional (HCP) discussions. However, no studies outline how migraine is actually discussed during clinical encounters.
  
  
  OBJECTIVE
  Record naturally occurring HCP-migraineur interactions, analyzing frequency and impairment assessment, and preventive treatment discussions.
  
  
  METHODS
  HCPs seeing high volumes of migraineurs were recruited for a communication study. Patients likely to discuss migraine were recruited immediately before their normally scheduled appointment and, once consented, were audio- and video-recorded without a researcher present. Separate post-visit interviews were conducted with patients and HCPs. All interactions were transcribed.
  
  
  METHODS
  Sixty patients (83% female; mean age 41.7) were analyzed. Patients were diagnosed with migraine 14 years and experienced 5 per month, on average.
  
  
  METHODS
  Transcripts were analyzed using sociolinguistic techniques such as number and type of questions asked and post-visit alignment on migraine frequency and impairment. American Migraine Prevalence and Prevention Study guidelines were utilized.
  
  
  RESULTS
  Ninety-one percent of HCP-initiated, migraine-specific questions were closed-ended/short answer; assessments focused on frequency and did not focus on attention on impairment. Open-ended questions in patient post-visit interviews yielded robust impairment-related information. Post-visit, 55% of HCP-patient pairs were misaligned regarding frequency; 51% on impairment. Of the 20 (33%) patients who were preventive medication candidates, 80% did not receive it and 50% of their visits lacked discussion of prevention.
  
  
  CONCLUSIONS
  Sociolinguistic analysis revealed that HCPs often used narrowly focused, closed-ended questions and were often unaware of how migraine affected patients' lives as a result. It is recommended that HCPs assess impairment using open-ended questions in combination with the ask-tell-ask technique.
authors.affiliation: Department of Neurology, Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA. rlipton@aecom.yu.edu
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
authors.forename: Steven R
authors.initials: SR
authors.lastname: Hahn
authors.forename: Roger K
authors.initials: RK
authors.lastname: Cady
authors.forename: Jan Lewis
authors.initials: JL
authors.lastname: Brandes
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Simons
authors.forename: Philip A
authors.initials: PA
authors.lastname: Bain
authors.forename: Meaghan R
authors.initials: MR
authors.lastname: Nelson
mesh_terms: D000328:Adult; D003142:Communication; D015897:Comorbidity; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000503:physiopathology* / Q000517:prevention & control*; D009819:Office Visits; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires