title: A migraine management training program for primary care providers: An overview of a survey and pilot study findings, lessons learned, and considerations for further research.
abstract: BACKGROUND
  There are five to nine million primary care office visits a year for migraine in the United States. However, migraine care is often suboptimal in the primary care setting. A prior study indicated that primary care physicians (PCPs) wanted direct contact with headache specialists to improve the migraine care they provide.
  
  
  OBJECTIVE
  We sought to further examine PCPs' knowledge of migraine management and assess the feasibility of a multimodal migraine education program for PCPs.
  
  
  METHODS
  We conducted a survey assessing PCPs' knowledge about migraine. We then held three live educational sessions and developed an email consultative service for PCPs to submit questions they had about migraine. We report both quantitative and qualitative findings.
  
  
  RESULTS
  Twenty-one PCPs completed the survey. They were generally familiar with the epidemiology of migraine (mean prevalence of migraine reported was 12.6% ± 10.1), the psychiatric comorbidities (mean prevalence of comorbid depression was 24.5% ± 16.7, mean prevalence of comorbid anxiety was 24.6% ± 18.3), and evidence-based behavioral treatments. Fifty-six percent cited cognitive behavioral therapy, 78% cited biofeedback, and 61% cited relaxation therapy as evidence based treatments. Though most were aware of the prevalence of psychiatric comorbidities, they did not routinely assess for them (43% did not routinely assess for anxiety, 29% did not routinely assess for depression). PCPs reported frequently referring patients for non-level A evidence based treatments: special diets (60%), acupuncture (50%), physical therapy (30%), and psychoanalysis (20%). Relaxation therapy was a therapy recommended by 40% of the PCPs. Only 10% reported referring for cognitive behavioral therapy or biofeedback. Nineteen percent made minimal or no use of migraine preventive medications. Seventy-two percent were unaware of or only slightly aware of the American Academy of Neurology guidelines for migraine. There was variable attendance at the educational sessions (N=22 at 1st session, 6 at 2nd session, 15 at 3rd session). Very few PCPs used the email consultative service (N=4).
  
  
  CONCLUSIONS
  Though PCPs are familiar with many aspects of migraine care, there is a need and opportunity for improvement. The three live sessions were poorly attended and the email consultative service was rarely used. We provide an in depth discussion of targeted areas for educational intervention, of the challenges in developing a migraine educational program for PCPs, and areas for future study.
authors.affiliation: NYU Langone Medical Center.
authors.forename: Mia
authors.initials: M
authors.lastname: Minen
authors.affiliation: Barnard College, Columbia University.
authors.forename: Ashna
authors.initials: A
authors.lastname: Shome
authors.affiliation: NYU Langone Medical Center.
authors.forename: Audrey
authors.initials: A
authors.lastname: Halpern
authors.affiliation: Brigham and Women's Hospital.
authors.forename: Lori
authors.initials: L
authors.lastname: Tishler
authors.affiliation: University of Utah Medical Center.
authors.forename: K C
authors.initials: KC
authors.lastname: Brennan
authors.affiliation: Brigham and Women's Faulkner Hospital.|Harvard Medical School.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Loder
authors.affiliation: Albert Einstein College of Medicine.
authors.forename: Richard
authors.initials: R
authors.lastname: Lipton
authors.affiliation: Brigham and Women's Hospital.|Brigham and Women's Faulkner Hospital.|Harvard Medical School.
authors.forename: David
authors.initials: D
authors.lastname: Silbersweig
mesh_terms: D000328:Adult; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000628:therapy*; D020380:Needs Assessment; D058007:Physicians, Primary Care; D010865:Pilot Projects; D011795:Surveys and Questionnaires
keywords: diagnosis; education; migraine; primary care; telemedicine; treatment