title: Migraine diagnosis and treatment: A knowledge and needs assessment among primary care providers.
abstract: BACKGROUND
  Studies reveal that migraine is often under-recognized, misdiagnosed and inadequately treated in the primary care setting.
  
  
  OBJECTIVE
  The objective of this article is to assess primary care providers' (PCP) knowledge and needs regarding migraine diagnosis and management.
  
  
  METHODS
  We held semi-structured group interviews and distributed a brief questionnaire to PCPs in our hospital network. Building on the information from the interviews, we developed a comprehensive survey assessing PCPs' knowledge about migraine. Descriptive analyses were performed.
  
  
  RESULTS
  The initial interviews and brief questionnaires revealed that PCPs are aware of the prevalence of migraine but are uncertain about the details of management. Eighty-three of 120 physicians completed the comprehensive survey. Only 47% would order imaging for a new type of headache, 31% for worsening headache, and 35% for a headache unresponsive to treatment. Only 28% were familiar with the American Academy of Neurology guidelines on preventive treatment and 40% were familiar with the Choosing Wisely Campaign recommendations on migraine treatment. Just 34% were aware that opioids can cause medication-overuse headache. Non-pharmacologic treatment was not usually recommended. PCPs favored educational opportunities involving direct contact with headache physicians (56%).
  
  
  CONCLUSIONS
  PCPs are not universally aware of the specific recommendations for managing migraine patients. Future work should focus on innovative ways to provide decision support and education for PCPs caring for migraineurs.
authors.affiliation: NYU Langone Medical Center, USA Minenmd@gmail.com.
authors.forename: Mia T
authors.initials: MT
authors.lastname: Minen
authors.affiliation: Brigham and Women's Faulkner Hospital, USA Harvard Medical School, USA Brigham and Women's Hospital, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Loder
authors.affiliation: Harvard Medical School, USA Brigham and Women's Hospital, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Tishler
authors.affiliation: Harvard Medical School, USA Brigham and Women's Hospital, USA.
authors.forename: David
authors.initials: D
authors.lastname: Silbersweig
mesh_terms: D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000628:therapy*; D020380:Needs Assessment; D058007:Physicians, Primary Care; D011795:Surveys and Questionnaires
keywords: Primary care; diagnosis; education; migraine; treatment