Hartford Healthcare Headache Center, Ayer Neuroscience Institute, West Hartford, CT, USA.
Division of Health Psychology, The Institute of Living/Hartford Hospital, Hartford, CT, USA.
Headache. 2021 Jan;61(1):69-79. doi: 10.1111/head.14027. Epub 2020 Dec 30.
Studies suggest that migraine is often underdiagnosed and inadequately treated in the primary care setting, despite many patients relying on their primary care provider (PCP) to manage their migraine. Many women consider their women's healthcare provider to be their PCP, yet very little is known about migraine knowledge and practice patterns in the women's healthcare setting.
The objective of this study was to assess women's healthcare providers' knowledge and needs regarding migraine diagnosis and treatment.
The comprehensive survey assessing migraine knowledge originally developed for PCPs was used in this study, with the addition of a section regarding the use of hormonal medications in patients impacted by migraine. Surveys were distributed online, and primarily descriptive analyses were performed.
The online survey was completed by 115 women's healthcare providers (response rate 28.6%; 115/402), who estimated that they serve as PCPs for approximately one-third of their patients. Results suggest that women's healthcare providers generally recognize the prevalence of migraine, but experience some knowledge gaps regarding migraine management. Despite 82.6% (95/115) of survey respondents feeling very comfortable or somewhat comfortable with diagnosing migraine, only 57.9% (66/114) reported routinely asking patients about headaches during annual visits. Very few were familiar with the American Academy of Neurology guidelines on preventative treatment (6.3%; 7/111) and the Choosing Wisely Campaign recommendations on migraine treatment (17.3%; 19/110), and many prescribed medications known to contribute to medication overuse headache. In addition, only 24.3% (28/115) would order imaging for a new type of headache, 35.7% (41/115) for worsening headache, and 47.8% (55/115) for headache with neurologic symptoms; respondents cited greater tendency with sending patients to an emergency department for the same symptoms. Respondents had limited knowledge of evidence-based, non-pharmacological treatments for migraine (i.e., biofeedback or cognitive behavioral therapy), with nearly none placing referrals for these services. Most providers were comfortable prescribing hormonal contraception (mainly progesterone only) to women with migraine without aura (80.9%; 89/110) and with aura (72.5%; 79/109), and followed American College of Obstetricians and Gynecologists (ACOG) guidelines to limit combination hormonal contraception for patients with aura. When queried, 6.3% or less (5/79) of providers would prescribe estrogen-containing contraception for women with migraine with aura. Only 37.3% (41/110) of respondents reported having headache/migraine education. Providers indicated interest in education pertaining to migraine prevention and treatment (96.3%; 105/109), migraine-associated disability (74.3%; 81/109), and diagnostic testing (59.6%; 65/109).
Women's healthcare providers appear to have several knowledge gaps regarding the management of migraine in their patients. These providers would likely benefit from access to a headache-specific educational curriculum to improve provider performance and patient outcomes.
尽管许多患者依赖初级保健提供者（PCP）来管理他们的偏头痛，但研究表明，偏头痛在初级保健环境中经常被误诊和治疗不足。许多女性认为她们的妇科保健提供者就是她们的 PCP，但对于妇科保健环境中偏头痛的知识和实践模式知之甚少。
本研究旨在评估女性健康保健提供者在偏头痛诊断和治疗方面的知识和需求。
使用最初为 PCP 开发的全面评估偏头痛知识的综合调查在本研究中使用，并且增加了关于在受偏头痛影响的患者中使用激素药物的部分。调查通过在线分发，主要进行描述性分析。
115 名女性健康保健提供者（响应率 28.6%；115/402）完成了在线调查，他们估计他们为大约三分之一的患者提供 PCP 服务。结果表明，女性健康保健提供者通常认识到偏头痛的普遍性，但在偏头痛管理方面存在一些知识差距。尽管 82.6%（95/115）的调查受访者对诊断偏头痛非常有信心或有些有信心，但只有 57.9%（66/114）报告在年度就诊时经常询问患者头痛情况。很少有人熟悉美国神经病学学会预防治疗指南（6.3%；7/111）和明智选择运动关于偏头痛治疗的建议（17.3%；19/110），并且许多人开了已知会导致药物过度使用性头痛的药物。此外，只有 24.3%（28/115）会为新发头痛开影像学检查，35.7%（41/115）为头痛加重，47.8%（55/115）为伴有神经系统症状的头痛；受访者表示更倾向于将同样症状的患者送往急诊室。受访者对偏头痛的基于证据的非药物治疗方法（即生物反馈或认知行为疗法）了解有限，几乎没有人会推荐这些服务。大多数提供者对无先兆偏头痛（80.9%；89/110）和有先兆偏头痛（72.5%；79/109）的女性患者开具激素避孕处方（主要是孕激素）感到舒适，并遵循美国妇产科医师学会（ACOG）的指导方针，限制有先兆偏头痛患者使用联合激素避孕。当被询问时，不到 6.3%（5/79）的提供者会为有先兆偏头痛的女性开具含雌激素的避孕处方。只有 37.3%（41/110）的受访者报告接受过头痛/偏头痛教育。提供者表示对偏头痛预防和治疗（96.3%；105/109）、偏头痛相关残疾（74.3%；81/109）和诊断测试（59.6%；65/109）的教育感兴趣。
女性健康保健提供者在管理患者偏头痛方面似乎存在一些知识差距。这些提供者可能受益于获得专门针对头痛的教育课程，以提高提供者的绩效和患者的治疗效果。
