title: Prophylactic treatment of migraine by GPs: a qualitative study.
abstract: BACKGROUND
  Despite the considerable impact of migraine, the use of preventive medication in primary care is limited. Only about 5% of migraine patients who qualify for prophylaxis actually receive it, and adherence is far from optimal.
  
  
  OBJECTIVE
  To explore the  opinions of GPs regarding preventive medication for migraine.
  
  
  METHODS
  A qualitative focus group study in Dutch general practice.
  
  
  METHODS
  Four focus groups (six GPs each) were formed. GPs were purposively sampled to acquire a range of participants,  reflecting the more general GP population.
  
  
  RESULTS
  GPs perceived patients' concerns about the impact of migraine and the potential benefits of prophylaxis. However, some were hesitant to start prescribing prophylaxis due to doubts about effectiveness, potential side effects,  and the risk of developing drug dependency. GPs' decisions were often based on considerations other than those presented in national guidelines, for example, the patient's need to control their own problem. Many GPs placed responsibility for initiating prophylaxis with the patient.
  
  
  CONCLUSIONS
  Various considerations hamper GPs from managing migraine with preventive medication, and various patient-related concerns cause GPs to deviate from national headache guidelines.
authors.affiliation: Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. f.dekker@lumc.nl
authors.forename: Frans
authors.initials: F
authors.lastname: Dekker
authors.forename: Arie Knuistingh
authors.initials: AK
authors.lastname: Neven
authors.forename: Boukje
authors.initials: B
authors.lastname: Andriesse
authors.forename: David
authors.initials: D
authors.lastname: Kernick
authors.forename: Michel D
authors.initials: MD
authors.lastname: Ferrari
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D005194:Family Practice; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000517:prevention & control*; D017060:Patient Satisfaction; D010465:Perception; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome
chemical_list: D000700:Analgesics